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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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":7569.08,"10th_percentile":7569.08,"90th_percentile":7569.08,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16259.0,"10th_percentile":16259.0,"90th_percentile":16259.0,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":65860.02,"10th_percentile":44557.46,"90th_percentile":98295.07,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":62740.74,"10th_percentile":62740.74,"90th_percentile":62740.74,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":12263.7,"10th_percentile":12263.7,"90th_percentile":12263.7,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15898.78,"10th_percentile":15898.78,"90th_percentile":15898.78,"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":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":50183.51,"10th_percentile":17657.7,"90th_percentile":272440.08,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":7086.35,"10th_percentile":7086.35,"90th_percentile":7795.25,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16382.36,"10th_percentile":16224.18,"90th_percentile":16422.27,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":16462.42,"10th_percentile":16462.42,"90th_percentile":16462.42,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":37301.07,"10th_percentile":37301.07,"90th_percentile":37301.07,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14758.96,"10th_percentile":14758.96,"90th_percentile":16341.11,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":11457.8,"maximum":21429.76,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16277.82},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11457.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11457.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15845.41},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":16338.7},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17150.33},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11457.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11457.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":18641.66},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11457.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11457.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11457.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11457.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11457.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11457.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11457.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21429.76},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19574.42},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11457.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16277.82,"10th_percentile":16277.82,"90th_percentile":16277.82,"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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":5254.44,"10th_percentile":5254.44,"90th_percentile":5254.44,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9436.01,"10th_percentile":8326.23,"90th_percentile":9698.23,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":53327.6,"10th_percentile":53327.6,"90th_percentile":53327.6,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":56633.26,"10th_percentile":41732.98,"90th_percentile":76324.78,"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":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":20288.07,"10th_percentile":16733.5,"90th_percentile":82715.7,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":21638.62,"10th_percentile":21638.62,"90th_percentile":21638.62},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":6260.36,"10th_percentile":5254.44,"90th_percentile":7795.25,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9124.92,"10th_percentile":3793.36,"90th_percentile":9701.39,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8199.59,"10th_percentile":8199.59,"90th_percentile":8199.59,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":5776.69,"10th_percentile":5776.69,"90th_percentile":5776.69,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":19275.06,"10th_percentile":19275.06,"90th_percentile":19275.06,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8422.96,"10th_percentile":3682.73,"90th_percentile":9378.5,"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":"Youthcare","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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25905.54,"10th_percentile":25905.54,"90th_percentile":25905.54,"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":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":16690.1,"10th_percentile":16690.1,"90th_percentile":16690.1,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":17045.92,"maximum":31709.48,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24086.19},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17045.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17045.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23446.36},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":24176.28},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25377.24},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17045.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17045.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":27583.96},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17045.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17045.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17045.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17045.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17045.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17045.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17045.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31709.48},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28964.15},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17045.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23110.27,"10th_percentile":23110.27,"90th_percentile":33743.51,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":7199.63,"10th_percentile":7021.31,"90th_percentile":7716.45,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14172.47,"10th_percentile":14155.04,"90th_percentile":14629.77,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12518.39,"10th_percentile":12518.39,"90th_percentile":12518.39,"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":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":49877.65,"10th_percentile":49877.65,"90th_percentile":49877.65,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":51153.9,"10th_percentile":42587.61,"90th_percentile":83832.69,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14455.59,"10th_percentile":14455.59,"90th_percentile":16577.08,"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":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":25065.7,"10th_percentile":25065.7,"90th_percentile":39691.11,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":31644.29,"10th_percentile":31644.29,"90th_percentile":31644.29},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":6665.73,"10th_percentile":6665.73,"90th_percentile":6665.73,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12760.8,"10th_percentile":12760.8,"90th_percentile":12760.8,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"15","median_amount":14155.0,"10th_percentile":11463.64,"90th_percentile":14182.34,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12676.39,"10th_percentile":12676.39,"90th_percentile":12676.39,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":14698.4,"10th_percentile":14698.4,"90th_percentile":14698.4,"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":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11837.41,"10th_percentile":11837.41,"90th_percentile":11837.41,"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 Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":31711.23,"10th_percentile":31711.23,"90th_percentile":31711.23,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"1 through 10","median_amount":28965.74,"10th_percentile":28965.74,"90th_percentile":28965.74,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12914.78,"10th_percentile":7749.55,"90th_percentile":14167.56,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":9389.36,"maximum":17195.08,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13061.2},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9389.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9389.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12714.25},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":13110.05},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13761.3},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9389.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9389.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":14957.94},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9389.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9389.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9389.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9389.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9389.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9389.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9389.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17195.08},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15706.37},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9389.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15326.18,"10th_percentile":12817.26,"90th_percentile":30301.53,"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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"17","median_amount":7850.61,"10th_percentile":6520.57,"90th_percentile":8088.24,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":501.06,"10th_percentile":501.06,"90th_percentile":501.06,"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":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":46289.16,"10th_percentile":27121.81,"90th_percentile":72968.02,"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":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":43663.51,"10th_percentile":28333.2,"90th_percentile":45359.78,"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":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":4807.0,"10th_percentile":4419.11,"90th_percentile":4853.64,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7869.4,"10th_percentile":7856.8,"90th_percentile":9484.24,"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":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7636.06,"10th_percentile":7636.06,"90th_percentile":7636.06,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":32216.84,"10th_percentile":22937.12,"90th_percentile":62057.26,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":12304.26,"10th_percentile":8970.79,"90th_percentile":21613.8},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7116.9,"10th_percentile":7116.9,"90th_percentile":7116.9,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":5932.95,"10th_percentile":5304.06,"90th_percentile":7716.45,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"19","median_amount":7474.6,"10th_percentile":5255.69,"90th_percentile":8088.24,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":5304.06,"10th_percentile":4836.34,"90th_percentile":6812.59,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5666.85,"10th_percentile":5666.85,"90th_percentile":5666.85,"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":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":7620.15,"10th_percentile":7620.15,"90th_percentile":7620.15,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":17195.08,"10th_percentile":17195.08,"90th_percentile":17195.08,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"15","median_amount":7850.62,"10th_percentile":1623.49,"90th_percentile":8088.25,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Hemorrhage Without Cc/Mcc","code_information":[{"code":"379","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6223.9,"maximum":11102.94,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8433.68},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6223.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6223.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8209.64},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":8465.22},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8885.73},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6223.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6223.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":9658.41},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6223.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6223.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6223.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6223.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6223.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6223.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6223.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11102.94},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10141.67},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6223.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8351.54,"10th_percentile":8351.54,"90th_percentile":8351.54,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5217.91,"10th_percentile":5217.91,"90th_percentile":5217.91,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24415.31,"10th_percentile":24415.31,"90th_percentile":24415.31,"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":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4270.73,"10th_percentile":4270.73,"90th_percentile":4270.73,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":17415.72,"10th_percentile":17415.72,"90th_percentile":17415.72,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":8877.32,"10th_percentile":8877.32,"90th_percentile":8877.32},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4896.61,"10th_percentile":4896.61,"90th_percentile":4896.61,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complicated Peptic Ulcer With Mcc","code_information":[{"code":"380","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18258.61,"maximum":33561.72,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25493.13},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18258.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18258.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24815.93},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":25588.48},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26859.59},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18258.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18258.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":29195.21},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18258.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18258.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18258.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18258.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18258.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18258.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18258.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33561.72},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30656.02},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18258.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":58889.01,"10th_percentile":58889.01,"90th_percentile":58889.01,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14978.22,"10th_percentile":14978.22,"90th_percentile":14978.22,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":11166.01,"10th_percentile":11166.01,"90th_percentile":11166.01,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13148.03,"10th_percentile":12998.72,"90th_percentile":15572.9,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complicated Peptic Ulcer With Cc","code_information":[{"code":"381","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10318.3,"maximum":18994.99,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14428.4},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10318.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10318.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14045.12},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":14482.36},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15201.78},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10318.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10318.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":16523.67},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10318.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10318.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10318.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10318.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10318.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10318.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10318.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18994.99},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17350.45},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10318.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":5163.41,"10th_percentile":5163.41,"90th_percentile":5163.41,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5341.75,"10th_percentile":5341.75,"90th_percentile":5341.75,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24560.55,"10th_percentile":24560.55,"90th_percentile":24560.55,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":34987.12,"10th_percentile":34987.12,"90th_percentile":34987.12,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":16423.47,"10th_percentile":16423.47,"90th_percentile":16423.47},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":6737.86,"10th_percentile":6737.86,"90th_percentile":6737.86,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":6426.61,"10th_percentile":6426.61,"90th_percentile":6426.61,"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":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8639.18,"10th_percentile":8639.18,"90th_percentile":8639.18,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complicated Peptic Ulcer Without Cc/Mcc","code_information":[{"code":"382","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7761.9,"maximum":13068.54,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9926.73},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7761.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7761.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9663.03},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":9963.85},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10458.81},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7761.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7761.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11368.27},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7761.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7761.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7761.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7761.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7761.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7761.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7761.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13068.54},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11937.1},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7761.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":4409.48,"10th_percentile":4409.48,"90th_percentile":4409.48,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5686.72,"10th_percentile":5686.72,"90th_percentile":5686.72,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":32124.1,"10th_percentile":32124.1,"90th_percentile":32124.1,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5981.9,"10th_percentile":5981.9,"90th_percentile":5981.9,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uncomplicated Peptic Ulcer With Mcc","code_information":[{"code":"383","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13003.93,"maximum":22048.91,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16748.12},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13003.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13003.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16303.22},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":16810.76},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17645.84},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13003.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13003.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":19180.27},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13003.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13003.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13003.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13003.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13003.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13003.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13003.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22048.91},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20139.97},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13003.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":26836.45,"10th_percentile":26836.45,"90th_percentile":26836.45,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uncomplicated Peptic Ulcer Without Mcc","code_information":[{"code":"384","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8251.67,"maximum":15166.69,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11520.46},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8251.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8251.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11214.43},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11563.55},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12137.97},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8251.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8251.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":13193.45},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8251.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8251.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8251.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8251.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8251.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8251.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8251.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15166.69},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13853.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8251.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":5288.29,"10th_percentile":5288.29,"90th_percentile":5288.29,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":5372.16,"10th_percentile":5372.16,"90th_percentile":5372.16,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12960.49,"10th_percentile":12960.49,"90th_percentile":12960.49,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":32222.77,"10th_percentile":32222.77,"90th_percentile":32222.77,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":6033.65,"10th_percentile":6033.65,"90th_percentile":6033.65,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12700.31,"10th_percentile":12700.31,"90th_percentile":12700.31,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":34594.88,"10th_percentile":34594.88,"90th_percentile":34594.88,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammatory Bowel Disease With Cc","code_information":[{"code":"386","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9349.6,"maximum":17308.45,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13147.32},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9349.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9349.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12798.07},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":13196.49},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13852.03},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9349.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9349.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":15056.55},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9349.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9349.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9349.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9349.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9349.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9349.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9349.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17308.45},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15809.92},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9349.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":50459.42,"10th_percentile":50459.42,"90th_percentile":50459.42,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":34655.29,"10th_percentile":24860.98,"90th_percentile":35059.31,"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":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":56257.9,"10th_percentile":56257.9,"90th_percentile":56257.9,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5999.07,"10th_percentile":5999.07,"90th_percentile":5999.07,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":45417.04,"10th_percentile":26524.09,"90th_percentile":84860.65,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":14617.21,"10th_percentile":14617.21,"90th_percentile":14617.21},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7520.32,"10th_percentile":7306.43,"90th_percentile":7912.95,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":6401.06,"10th_percentile":4955.03,"90th_percentile":7915.13,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7919.9,"10th_percentile":7919.9,"90th_percentile":7919.9,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":6683.85,"maximum":11690.7,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8880.13},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6683.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6683.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8644.24},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":8913.35},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9356.12},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6683.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6683.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10169.7},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6683.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6683.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6683.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6683.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6683.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6683.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6683.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11690.7},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10678.55},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6683.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":42030.47,"10th_percentile":42030.47,"90th_percentile":42030.47,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":28136.96,"10th_percentile":19216.02,"90th_percentile":42557.86,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":5833.84,"10th_percentile":5833.84,"90th_percentile":5833.84,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":32913.11,"10th_percentile":25176.96,"90th_percentile":45984.73,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":11070.84,"10th_percentile":11070.84,"90th_percentile":11070.84},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4890.86,"10th_percentile":4890.86,"90th_percentile":4890.86,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":1044.83,"10th_percentile":1044.83,"90th_percentile":1044.83,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":11160.5,"10th_percentile":11160.5,"90th_percentile":11160.5,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5464.05,"10th_percentile":5464.05,"90th_percentile":5464.05,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Obstruction With Mcc","code_information":[{"code":"388","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13872.33,"maximum":25638.27,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19474.56},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13872.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13872.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18957.24},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":19547.4},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20518.42},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13872.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13872.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":22302.63},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13872.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13872.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13872.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13872.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13872.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13872.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13872.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25638.27},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23418.57},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13872.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":12519.45,"10th_percentile":12519.45,"90th_percentile":12519.45,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6614.88,"10th_percentile":6458.55,"90th_percentile":11523.74,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":23750.23,"10th_percentile":23750.23,"90th_percentile":23750.23,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":106577.75,"10th_percentile":106577.75,"90th_percentile":106577.75,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":6523.51,"10th_percentile":6523.51,"90th_percentile":6523.51,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11516.75,"10th_percentile":11516.75,"90th_percentile":11516.75,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11181.07,"10th_percentile":11181.07,"90th_percentile":11181.07,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"12","median_amount":44746.07,"10th_percentile":28214.52,"90th_percentile":100907.36,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10332.15,"10th_percentile":8601.25,"90th_percentile":11526.88,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":6782.67,"10th_percentile":6782.67,"90th_percentile":6782.67,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":1257.98,"10th_percentile":1257.98,"90th_percentile":1257.98,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":25636.53,"10th_percentile":25636.53,"90th_percentile":25636.53,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11529.68,"10th_percentile":6529.03,"90th_percentile":11918.35,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":7664.3,"maximum":13982.45,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10620.92},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7664.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7664.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10338.79},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":10660.65},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11190.22},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7664.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7664.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":12163.28},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7664.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7664.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7664.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7664.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7664.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7664.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7664.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13982.45},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12771.88},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7664.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10264.92,"10th_percentile":7700.75,"90th_percentile":11226.04,"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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":5566.25,"10th_percentile":5566.25,"90th_percentile":5566.25,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4527.58,"10th_percentile":3939.54,"90th_percentile":6473.96,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6457.16,"10th_percentile":6457.16,"90th_percentile":6457.16,"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":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":24664.88,"10th_percentile":24664.88,"90th_percentile":24664.88,"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":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20332.18,"10th_percentile":18106.64,"90th_percentile":52294.92,"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":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":4085.39,"10th_percentile":4085.39,"90th_percentile":4085.39,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6454.59,"10th_percentile":6454.59,"90th_percentile":6454.59,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6266.31,"10th_percentile":6266.31,"90th_percentile":6266.31,"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":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"14","median_amount":19829.24,"10th_percentile":16809.06,"90th_percentile":37608.93,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":21910.83,"10th_percentile":21910.83,"90th_percentile":21910.83},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":4338.94,"10th_percentile":4338.94,"90th_percentile":4338.94,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5660.27,"10th_percentile":4539.25,"90th_percentile":6466.29,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6564.61,"10th_percentile":6564.61,"90th_percentile":6564.61,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":4481.11,"10th_percentile":4481.11,"90th_percentile":4481.11,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":9543.72,"10th_percentile":7369.89,"90th_percentile":13346.64,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6460.12,"10th_percentile":4529.08,"90th_percentile":6510.12,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Obstruction Without Cc/Mcc","code_information":[{"code":"390","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5443.15,"maximum":9541.97,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7247.98},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5443.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5443.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7055.45},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":7275.09},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7636.48},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5443.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5443.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":8300.52},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5443.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5443.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5443.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5443.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5443.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5443.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5443.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9541.97},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8715.85},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5443.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7701.3,"10th_percentile":7701.3,"90th_percentile":7701.3,"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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":3539.78,"10th_percentile":3539.78,"90th_percentile":3539.78,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"11","median_amount":4531.02,"10th_percentile":4263.11,"90th_percentile":4551.02,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18569.85,"10th_percentile":17618.08,"90th_percentile":22747.69,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":3539.78,"10th_percentile":3539.78,"90th_percentile":3539.78,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"19","median_amount":18862.78,"10th_percentile":12693.72,"90th_percentile":29833.9,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":4621.65,"10th_percentile":4621.65,"90th_percentile":4621.65,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4499.15,"10th_percentile":3675.52,"90th_percentile":4730.04,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":3539.78,"10th_percentile":3231.11,"90th_percentile":3539.78,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":9543.72,"10th_percentile":9543.72,"90th_percentile":9543.72,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"1 through 10","median_amount":8717.44,"10th_percentile":8717.44,"90th_percentile":8717.44,"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":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4527.59,"10th_percentile":4126.61,"90th_percentile":4538.74,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc","code_information":[{"code":"391","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11988.23,"maximum":22409.94,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17022.36},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11988.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11988.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16570.17},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":17086.02},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17934.78},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11988.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11988.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":19494.32},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11988.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11988.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11988.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11988.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11988.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11988.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11988.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22409.94},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20469.74},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11988.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16523.23,"10th_percentile":10337.41,"90th_percentile":19317.5,"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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":11891.75,"10th_percentile":11891.75,"90th_percentile":11891.75,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10139.25,"10th_percentile":9524.37,"90th_percentile":14245.21,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":26915.4,"10th_percentile":26915.4,"90th_percentile":26915.4,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"11","median_amount":37095.4,"10th_percentile":21592.9,"90th_percentile":56880.17,"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":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":3635.64,"10th_percentile":3635.64,"90th_percentile":3635.64,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10308.64,"10th_percentile":10116.41,"90th_percentile":32430.43,"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":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9817.62,"10th_percentile":9817.62,"90th_percentile":9817.62,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":33523.11,"10th_percentile":21627.17,"90th_percentile":181423.38,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":11986.58,"10th_percentile":11986.58,"90th_percentile":11986.58},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":4922.22,"10th_percentile":4922.22,"90th_percentile":4922.22,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10120.48,"10th_percentile":7995.61,"90th_percentile":10309.41,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8513.01,"10th_percentile":8513.01,"90th_percentile":8513.01,"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. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":6812.59,"10th_percentile":6282.31,"90th_percentile":8595.26,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":21426.79,"10th_percentile":21426.79,"90th_percentile":21898.27,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10116.54,"10th_percentile":2705.85,"90th_percentile":10160.76,"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":"Youthcare","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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient 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":3954.28,"10th_percentile":271.63,"90th_percentile":7064.81,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"21","median_amount":6298.16,"10th_percentile":3730.79,"90th_percentile":6535.65,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6295.75,"10th_percentile":6295.75,"90th_percentile":6295.75,"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":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":19674.11,"10th_percentile":14350.12,"90th_percentile":83014.74,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"24","median_amount":25646.53,"10th_percentile":13972.37,"90th_percentile":35547.31,"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":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient 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":4148.4,"10th_percentile":3143.51,"90th_percentile":6548.19,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6298.16,"10th_percentile":5709.35,"90th_percentile":6339.65,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6109.21,"10th_percentile":6109.21,"90th_percentile":6109.21,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"48","median_amount":20046.61,"10th_percentile":13550.71,"90th_percentile":43398.15,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":7002.03,"10th_percentile":6985.37,"90th_percentile":9704.89},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5748.39,"10th_percentile":5748.39,"90th_percentile":5748.39,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient 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":3425.24,"10th_percentile":2960.48,"90th_percentile":4359.7,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"18","median_amount":6189.96,"10th_percentile":5389.05,"90th_percentile":6535.65,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6293.21,"10th_percentile":6293.21,"90th_percentile":6293.21,"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":"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":"14","median_amount":3778.91,"10th_percentile":1135.74,"90th_percentile":4853.64,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4142.56,"10th_percentile":4142.56,"90th_percentile":4185.68,"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 Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":3288.44,"10th_percentile":3288.44,"90th_percentile":3288.44,"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":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"17","median_amount":13597.0,"10th_percentile":11154.57,"90th_percentile":13609.21,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"1 through 10","median_amount":12430.96,"10th_percentile":12430.96,"90th_percentile":12430.96,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"22","median_amount":6298.16,"10th_percentile":3682.08,"90th_percentile":6536.65,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System Diagnoses With Mcc","code_information":[{"code":"393","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14979.29,"maximum":28880.55,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21937.36},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14979.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14979.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21354.62},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":22019.41},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23113.23},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14979.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14979.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":25123.08},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14979.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14979.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14979.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14979.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14979.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14979.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14979.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28880.55},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26380.14},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14979.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18358.4,"10th_percentile":18358.4,"90th_percentile":18358.4,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":6849.46,"10th_percentile":6849.46,"90th_percentile":7078.94,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12937.83,"10th_percentile":12937.83,"90th_percentile":12937.83,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":117507.38,"10th_percentile":117507.38,"90th_percentile":117507.38,"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":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":37595.8,"10th_percentile":37595.8,"90th_percentile":37595.8,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":7395.8,"10th_percentile":7395.8,"90th_percentile":7395.8,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":42424.94,"10th_percentile":31103.39,"90th_percentile":92047.51,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":17372.19,"10th_percentile":17372.19,"90th_percentile":17372.19},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12926.43,"10th_percentile":12926.43,"90th_percentile":12926.43,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":8082.21,"10th_percentile":8082.21,"90th_percentile":8082.21,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12937.83,"10th_percentile":12887.13,"90th_percentile":49165.14,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":4281.3,"10th_percentile":4281.3,"90th_percentile":7078.94,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6124.13,"10th_percentile":6124.13,"90th_percentile":6124.13,"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 Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":7258.93,"10th_percentile":7258.93,"90th_percentile":7258.93,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":19133.69,"10th_percentile":19133.69,"90th_percentile":19133.69,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11761.6,"10th_percentile":11115.04,"90th_percentile":12926.43,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":8982.72,"maximum":16417.21,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12470.34},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8982.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8982.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12139.08},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":12516.98},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13138.77},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8982.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8982.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":14281.27},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8982.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8982.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8982.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8982.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8982.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8982.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8982.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16417.21},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14995.85},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8982.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9618.29,"10th_percentile":9618.29,"90th_percentile":9618.29,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":4229.88,"10th_percentile":4229.88,"90th_percentile":5203.58,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7514.67,"10th_percentile":2452.01,"90th_percentile":7740.79,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":29420.82,"10th_percentile":23515.63,"90th_percentile":81395.45,"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":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21817.96,"10th_percentile":21006.26,"90th_percentile":31762.31,"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":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":5380.73,"10th_percentile":5380.73,"90th_percentile":7691.4,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7544.78,"10th_percentile":7221.8,"90th_percentile":7898.77,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"19","median_amount":23985.09,"10th_percentile":17739.64,"90th_percentile":85735.14,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":13448.73,"10th_percentile":13448.73,"90th_percentile":13448.73},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6960.14,"10th_percentile":5210.84,"90th_percentile":7519.27,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7825.41,"10th_percentile":7825.41,"90th_percentile":7825.41,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":4883.21,"10th_percentile":4639.4,"90th_percentile":5837.26,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":5115.85,"10th_percentile":5115.85,"90th_percentile":16417.21,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"11","median_amount":7523.27,"10th_percentile":5689.98,"90th_percentile":7878.78,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/Mcc","code_information":[{"code":"373","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7100.43,"maximum":12649.96,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9608.77},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7100.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7100.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9353.53},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":9644.71},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10123.82},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7100.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7100.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11004.15},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7100.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7100.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7100.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7100.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7100.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7100.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7100.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12649.96},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11554.75},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7100.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9610.1,"10th_percentile":9610.1,"90th_percentile":9610.1,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2763.15,"10th_percentile":2763.15,"90th_percentile":2763.15,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":43158.56,"10th_percentile":43158.56,"90th_percentile":43158.56,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30880.13,"10th_percentile":20313.1,"90th_percentile":56098.23,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":4448.48,"10th_percentile":4448.48,"90th_percentile":4448.48,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"16","median_amount":27405.09,"10th_percentile":19002.23,"90th_percentile":42552.04,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5416.49,"10th_percentile":5416.49,"90th_percentile":5416.49,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":3508.54,"10th_percentile":3508.54,"90th_percentile":3508.54,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":4448.48,"10th_percentile":4448.48,"90th_percentile":4448.48,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":12651.7,"10th_percentile":12651.7,"90th_percentile":12651.7,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"1 through 10","median_amount":10654.96,"10th_percentile":10654.96,"90th_percentile":10654.96,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6151.44,"10th_percentile":6151.44,"90th_percentile":6151.44,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Gastrointestinal Disorders And Peritoneal Infections With Cc","code_information":[{"code":"372","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9753.52,"maximum":17952.02,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13636.17},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9753.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9753.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13273.94},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":13687.17},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14367.08},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9753.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9753.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":15616.4},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9753.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9753.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9753.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9753.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9753.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9753.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9753.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17952.02},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16397.78},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9753.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11191.31,"10th_percentile":11191.31,"90th_percentile":13636.17,"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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8179.34,"10th_percentile":6709.34,"90th_percentile":8189.31,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":29533.38,"10th_percentile":23986.6,"90th_percentile":55821.71,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":4886.26,"10th_percentile":4886.26,"90th_percentile":4886.26,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":25556.61,"10th_percentile":22055.89,"90th_percentile":102499.47,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":7851.66,"10th_percentile":7851.66,"90th_percentile":10943.91},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":4448.48,"10th_percentile":4448.48,"90th_percentile":4448.48,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7223.83,"10th_percentile":6841.63,"90th_percentile":8399.36,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":7931.66,"10th_percentile":7931.66,"90th_percentile":7931.66,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":21615.89,"10th_percentile":21615.89,"90th_percentile":21615.89,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":930.4,"10th_percentile":930.4,"90th_percentile":930.4,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"1 through 10","median_amount":14685.99,"10th_percentile":14685.99,"90th_percentile":14685.99,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8399.37,"10th_percentile":8399.37,"90th_percentile":8399.37,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Gastrointestinal Disorders And Peritoneal Infections With Mcc","code_information":[{"code":"371","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16549.82,"maximum":30492.1,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23161.48},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16549.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16549.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22546.22},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":23248.11},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24402.96},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16549.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16549.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":26524.96},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16549.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16549.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16549.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16549.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16549.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16549.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16549.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30492.1},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27852.17},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16549.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":6568.67,"10th_percentile":6568.67,"90th_percentile":6568.67,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13661.66,"10th_percentile":13661.66,"90th_percentile":13671.33,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":20762.96,"10th_percentile":20762.96,"90th_percentile":20762.96,"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":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26492.91,"10th_percentile":26492.91,"90th_percentile":26492.91,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":7258.47,"10th_percentile":7258.47,"90th_percentile":7258.47,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":95762.45,"10th_percentile":95762.45,"90th_percentile":95762.45,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":24096.82,"10th_percentile":24096.82,"90th_percentile":24096.82,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13647.03,"10th_percentile":13647.03,"90th_percentile":14205.92,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":11450.14,"10th_percentile":11450.14,"90th_percentile":11450.14,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12992.96,"10th_percentile":12992.96,"90th_percentile":12992.96,"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":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":514.07,"10th_percentile":514.07,"90th_percentile":514.07,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13623.3,"10th_percentile":13364.23,"90th_percentile":13635.33,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Esophageal Disorders Without Cc/Mcc","code_information":[{"code":"370","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6860.06,"maximum":12172.07,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9245.78},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6860.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6860.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9000.17},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":9280.36},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9741.36},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6860.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6860.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10588.44},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6860.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6860.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6860.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6860.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6860.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6860.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6860.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12172.07},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11118.24},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6860.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7851.16,"10th_percentile":7851.16,"90th_percentile":7851.16,"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":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":33394.2,"10th_percentile":28027.94,"90th_percentile":58661.82,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":4989.86,"10th_percentile":4989.86,"90th_percentile":4989.86,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":190.82,"10th_percentile":190.82,"90th_percentile":190.82,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8090.73,"10th_percentile":3180.74,"90th_percentile":8097.73,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Esophageal Disorders With Mcc","code_information":[{"code":"368","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14912.42,"maximum":29124.73,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22122.84},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14912.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14912.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21535.16},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":22205.58},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23308.65},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14912.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14912.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":25335.49},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14912.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14912.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14912.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14912.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14912.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14912.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14912.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29124.73},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26603.18},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14912.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21277.44,"10th_percentile":21277.44,"90th_percentile":21277.44,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6306.5,"10th_percentile":6306.5,"90th_percentile":6306.5,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":64791.66,"10th_percentile":64791.66,"90th_percentile":64791.66,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":96937.55,"10th_percentile":96937.55,"90th_percentile":96937.55,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":6737.86,"10th_percentile":6737.86,"90th_percentile":6737.86,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12806.96,"10th_percentile":12806.96,"90th_percentile":12806.96,"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":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11091.96,"10th_percentile":11091.96,"90th_percentile":11091.96,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13182.22,"10th_percentile":13182.22,"90th_percentile":13182.22,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":6247.79,"10th_percentile":6247.79,"90th_percentile":6247.79,"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":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":12143.32,"10th_percentile":12143.32,"90th_percentile":12143.32,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"1 through 10","median_amount":131806.2,"10th_percentile":131806.2,"90th_percentile":131806.2,"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":"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21953.28,"10th_percentile":21953.28,"90th_percentile":21953.28,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24597.56,"10th_percentile":24597.56,"90th_percentile":24597.56,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":103572.17,"10th_percentile":103572.17,"90th_percentile":103572.17,"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":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":117276.14,"10th_percentile":90712.03,"90th_percentile":159102.71,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24622.26,"10th_percentile":24622.26,"90th_percentile":24622.26,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24216.67,"10th_percentile":24216.67,"90th_percentile":24594.91,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc","code_information":[{"code":"323","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":39631.58,"maximum":74284.71,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56425.88},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39631.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39631.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":54926.98},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":56636.92},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":59450.38},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39631.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39631.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":64619.99},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39631.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39631.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39631.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39631.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39631.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39631.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39631.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":74284.71},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":67853.32},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39631.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":31868.27,"10th_percentile":31868.27,"90th_percentile":31868.27,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":114987.52,"10th_percentile":114987.52,"90th_percentile":114987.52,"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":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":119219.03,"10th_percentile":119219.03,"90th_percentile":119219.03,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":32211.27,"10th_percentile":32211.27,"90th_percentile":32211.27,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":16458.56,"maximum":31552.51,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23966.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16458.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16458.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23330.3},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":24056.6},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25251.62},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16458.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16458.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":27447.41},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16458.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16458.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16458.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16458.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16458.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16458.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16458.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31552.51},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28820.77},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16458.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"12","median_amount":23356.22,"10th_percentile":21377.01,"90th_percentile":65842.31,"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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":14104.82,"10th_percentile":14104.82,"90th_percentile":16015.03,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"12","median_amount":14100.86,"10th_percentile":14093.52,"90th_percentile":14150.56,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":103681.04,"10th_percentile":75626.0,"90th_percentile":115838.5,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":90172.32,"10th_percentile":77997.5,"90th_percentile":98362.74,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":15472.46,"10th_percentile":15472.46,"90th_percentile":16111.31,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14103.32,"10th_percentile":14086.86,"90th_percentile":14119.32,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":543.79,"10th_percentile":543.79,"90th_percentile":543.79,"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":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"42","median_amount":92894.13,"10th_percentile":71737.85,"90th_percentile":148917.28,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":31126.54,"10th_percentile":26075.88,"90th_percentile":40980.86},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15822.71,"10th_percentile":15822.71,"90th_percentile":15822.71,"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":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":15299.58,"10th_percentile":13765.22,"90th_percentile":21587.33,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12561.78,"10th_percentile":12561.78,"90th_percentile":12561.78,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"22","median_amount":13907.14,"10th_percentile":12966.64,"90th_percentile":14103.86,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":14653.72,"10th_percentile":13708.16,"90th_percentile":31554.26,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13445.8,"10th_percentile":13445.8,"90th_percentile":13445.8,"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 Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":14040.52,"10th_percentile":14040.52,"90th_percentile":14040.52,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":31431.46,"10th_percentile":29196.36,"90th_percentile":31554.26,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"1 through 10","median_amount":26744.49,"10th_percentile":26744.49,"90th_percentile":31554.26,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14090.87,"10th_percentile":12984.37,"90th_percentile":14142.95,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ Arteries/Intraluminal","code_information":[{"code":"321","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25113.65,"maximum":49649.29,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37713.08},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25113.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25113.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36711.27},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":37854.14},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39734.55},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25113.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25113.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":43189.73},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25113.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25113.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25113.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25113.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25113.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25113.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25113.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49649.29},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":45350.78},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25113.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":34719.14,"10th_percentile":34719.14,"90th_percentile":71415.66,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":17901.49,"10th_percentile":17901.49,"90th_percentile":17901.49,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"12","median_amount":21956.93,"10th_percentile":19907.98,"90th_percentile":22014.98,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":83094.37,"10th_percentile":83094.37,"90th_percentile":101856.93,"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":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":123887.27,"10th_percentile":123887.27,"90th_percentile":140247.93,"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":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":18890.49,"10th_percentile":18890.49,"90th_percentile":18890.49,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21946.39,"10th_percentile":21946.39,"90th_percentile":21958.19,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21288.0,"10th_percentile":21288.0,"90th_percentile":21288.0,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"19","median_amount":108548.38,"10th_percentile":83621.53,"90th_percentile":198387.57,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":28543.41,"10th_percentile":28543.41,"90th_percentile":32392.27,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21554.18,"10th_percentile":13524.94,"90th_percentile":25254.58,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":66577.01,"10th_percentile":66577.01,"90th_percentile":66577.01,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":26388.07,"10th_percentile":26388.07,"90th_percentile":26388.07,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19463.3,"10th_percentile":19463.3,"90th_percentile":19463.3,"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":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":18814.19,"10th_percentile":18814.19,"90th_percentile":18814.19,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":49651.04,"10th_percentile":47399.22,"90th_percentile":52642.96,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"1 through 10","median_amount":43979.63,"10th_percentile":42315.75,"90th_percentile":90721.2,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21946.4,"10th_percentile":14088.87,"90th_percentile":21995.39,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endovascular Cardiac Valve Procedures Without Mcc","code_information":[{"code":"320","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22262.65,"maximum":40368.94,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30663.82},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22262.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22262.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29849.27},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":30778.51},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32307.44},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22262.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22262.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":35116.79},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22262.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22262.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22262.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22262.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22262.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22262.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22262.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40368.94},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36873.89},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22262.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17931.19,"10th_percentile":17931.19,"90th_percentile":17931.19,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7303.61,"10th_percentile":7303.61,"90th_percentile":7303.61,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":12289.8,"10th_percentile":12289.8,"90th_percentile":12289.8,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17964.04,"10th_percentile":17964.04,"90th_percentile":17964.04,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endovascular Cardiac Valve Procedures With Mcc","code_information":[{"code":"319","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":40856.01,"maximum":76609.59,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58191.84},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40856.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40856.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":56646.03},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":58409.49},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":61311.0},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40856.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40856.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":66642.4},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40856.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40856.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40856.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40856.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40856.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40856.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40856.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":76609.59},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":69976.92},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40856.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":33668.9,"10th_percentile":33668.9,"90th_percentile":33668.9,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":34972.4,"10th_percentile":34972.4,"90th_percentile":34972.4,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30166.81,"10th_percentile":30166.81,"90th_percentile":30166.81,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":60949.42,"maximum":107890.03,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":81952.13},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60949.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60949.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":79775.15},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":82258.64},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":86344.87},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60949.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60949.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":93853.13},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60949.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60949.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60949.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60949.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60949.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60949.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60949.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":107890.03},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":98549.17},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60949.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":47242.93,"10th_percentile":47242.93,"90th_percentile":47242.93,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20783.86,"10th_percentile":20783.86,"90th_percentile":20783.86,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":234786.23,"10th_percentile":234786.23,"90th_percentile":234786.23,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":6691.08,"maximum":11905.23,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9043.08},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6691.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6691.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8802.86},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":9076.91},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9527.81},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6691.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6691.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10356.31},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6691.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6691.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6691.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6691.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6691.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6691.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6691.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11905.23},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10874.5},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6691.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5553.94,"10th_percentile":5553.94,"90th_percentile":5553.94,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":23280.02,"10th_percentile":23280.02,"90th_percentile":59802.57,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":9875.67,"10th_percentile":9875.67,"90th_percentile":9875.67,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"1 through 10","median_amount":10876.09,"10th_percentile":10876.09,"90th_percentile":10876.09,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":395.0,"10th_percentile":395.0,"90th_percentile":395.0,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":9232.12,"maximum":16783.47,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12748.55},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9232.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9232.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12409.9},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":12796.23},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13431.89},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9232.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9232.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":14599.88},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9232.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9232.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9232.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9232.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9232.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9232.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9232.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16783.47},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15330.4},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9232.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12748.55,"10th_percentile":12748.55,"90th_percentile":12748.55,"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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7678.48,"10th_percentile":6502.48,"90th_percentile":7692.96,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":35547.16,"10th_percentile":35547.16,"90th_percentile":35547.16,"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":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":36833.61,"10th_percentile":36833.61,"90th_percentile":36833.61,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":43124.94,"10th_percentile":20070.17,"90th_percentile":55420.36,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7671.85,"10th_percentile":7615.6,"90th_percentile":7691.35,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":232.16,"10th_percentile":232.16,"90th_percentile":232.16,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":1513.0,"10th_percentile":1513.0,"90th_percentile":1513.0,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7953.9,"10th_percentile":7953.9,"90th_percentile":7953.9,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":19370.09,"maximum":37557.45,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28528.24},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19370.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19370.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27770.42},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":28634.94},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30057.39},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19370.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19370.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":32671.08},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19370.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19370.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19370.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19370.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19370.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19370.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19370.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37557.45},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34305.82},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19370.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18832.05,"10th_percentile":18832.05,"90th_percentile":18832.05,"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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":6819.18,"10th_percentile":6819.18,"90th_percentile":6819.18,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16616.75,"10th_percentile":14821.87,"90th_percentile":16709.68,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15059.27,"10th_percentile":15059.27,"90th_percentile":15059.27,"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":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":71124.24,"10th_percentile":70443.32,"90th_percentile":235745.67,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":73774.7,"10th_percentile":73774.7,"90th_percentile":73774.7,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":12939.81,"10th_percentile":11994.86,"90th_percentile":17156.05,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16641.47,"10th_percentile":16641.47,"90th_percentile":16641.47,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16208.38,"10th_percentile":16208.38,"90th_percentile":16208.38,"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":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":57067.18,"10th_percentile":42978.34,"90th_percentile":208105.43,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7047.36,"10th_percentile":7047.36,"90th_percentile":7047.36,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":12877.61,"10th_percentile":12877.61,"90th_percentile":12890.02,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16615.47,"10th_percentile":7687.45,"90th_percentile":18942.63,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13856.95,"10th_percentile":13856.95,"90th_percentile":13856.95,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":6819.18,"10th_percentile":6819.18,"90th_percentile":11597.82,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":1043.84,"10th_percentile":1043.84,"90th_percentile":1043.84,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16615.47,"10th_percentile":10377.28,"90th_percentile":16709.67,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chest Pain","code_information":[{"code":"313","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7033.56,"maximum":12440.67,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9449.8},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7033.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7033.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9198.77},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":9485.14},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9956.32},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7033.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7033.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10822.09},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7033.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7033.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7033.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7033.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7033.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7033.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7033.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12440.67},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11363.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7033.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":4981.81,"10th_percentile":4981.81,"90th_percentile":4981.81,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":3467.95,"10th_percentile":3467.95,"90th_percentile":5791.4,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20486.36,"10th_percentile":20486.36,"90th_percentile":20486.36,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":6087.17,"10th_percentile":6087.17,"90th_percentile":6087.17,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6571.24,"10th_percentile":6571.24,"90th_percentile":6571.24,"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":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5893.67,"10th_percentile":5893.67,"90th_percentile":5893.67,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":3795.83,"10th_percentile":3795.83,"90th_percentile":3795.83,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":5151.7,"10th_percentile":5151.7,"90th_percentile":5151.7,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6075.51,"10th_percentile":6075.51,"90th_percentile":6075.51,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":8403.48,"maximum":15196.34,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11542.98},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8403.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8403.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11236.35},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11586.16},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12161.7},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8403.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8403.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":13219.24},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8403.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8403.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8403.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8403.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8403.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8403.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8403.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15196.34},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13880.68},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8403.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":4564.78,"10th_percentile":4564.78,"90th_percentile":4564.78,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6998.56,"10th_percentile":6988.03,"90th_percentile":7246.46,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":17573.13,"10th_percentile":17573.13,"90th_percentile":17573.13,"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":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":29380.22,"10th_percentile":29380.22,"90th_percentile":29380.22,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":4058.48,"10th_percentile":4058.48,"90th_percentile":4058.48,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5481.06,"10th_percentile":5481.06,"90th_percentile":5481.06,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":29153.92,"10th_percentile":25346.75,"90th_percentile":34180.41,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":6423.88,"10th_percentile":6423.88,"90th_percentile":6423.88,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"13","median_amount":6673.16,"10th_percentile":626.33,"90th_percentile":7245.92,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":4707.5,"10th_percentile":1786.57,"90th_percentile":6249.53,"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":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4817.23,"10th_percentile":4817.23,"90th_percentile":4817.23,"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 Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":15201.58,"10th_percentile":15201.58,"90th_percentile":15201.58,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6510.93,"10th_percentile":282.87,"90th_percentile":7245.93,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":6870.0,"maximum":12182.54,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9253.73},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6870.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6870.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9007.91},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":9288.34},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9749.74},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6870.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6870.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10597.54},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6870.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6870.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6870.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6870.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6870.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6870.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6870.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12182.54},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11127.8},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6870.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc","code_information":[{"code":"310","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5642.85,"maximum":9758.24,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7412.26},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5642.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5642.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7215.36},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":7439.98},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7809.56},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5642.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5642.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":8488.66},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5642.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5642.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5642.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5642.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5642.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5642.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5642.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9758.24},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8913.39},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5642.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4631.99,"10th_percentile":1531.8,"90th_percentile":5007.33,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25011.46,"10th_percentile":25011.46,"90th_percentile":25011.46,"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":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4630.6,"10th_percentile":4630.6,"90th_percentile":4630.6,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":34151.35,"10th_percentile":22245.2,"90th_percentile":41880.28,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4590.95,"10th_percentile":4590.95,"90th_percentile":4590.95,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":3002.12,"10th_percentile":3002.12,"90th_percentile":3002.12,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":9758.24,"10th_percentile":9758.24,"90th_percentile":9758.24,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4634.17,"10th_percentile":4624.61,"90th_percentile":4640.41,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrhythmia And Conduction Disorders With Cc","code_information":[{"code":"309","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7175.43,"maximum":12894.13,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9794.25},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7175.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7175.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9534.07},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":9830.88},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10319.23},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7175.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7175.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11216.56},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7175.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7175.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7175.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7175.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7175.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7175.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7175.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12894.13},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11777.79},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7175.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1530.05,"10th_percentile":1530.05,"90th_percentile":1530.05,"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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":4133.66,"10th_percentile":4133.66,"90th_percentile":4133.66,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"12","median_amount":5982.68,"10th_percentile":3154.6,"90th_percentile":6022.78,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":44827.04,"10th_percentile":44827.04,"90th_percentile":44827.04,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5099.82,"10th_percentile":5099.82,"90th_percentile":5099.82,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":4074.51,"10th_percentile":4074.51,"90th_percentile":4074.51,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5994.78,"10th_percentile":5994.78,"90th_percentile":5994.78,"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":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":26227.58,"10th_percentile":17895.52,"90th_percentile":119081.95,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4624.2,"10th_percentile":4624.2,"90th_percentile":4624.2,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"11","median_amount":5814.52,"10th_percentile":2953.13,"90th_percentile":6009.16,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5718.78,"10th_percentile":5718.78,"90th_percentile":5718.78,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":4074.51,"10th_percentile":4074.51,"90th_percentile":4133.66,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":1082.11,"10th_percentile":1082.11,"90th_percentile":1082.11,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":12053.33,"10th_percentile":12053.33,"90th_percentile":12053.33,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5982.69,"10th_percentile":285.67,"90th_percentile":6198.72,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrhythmia And Conduction Disorders With Mcc","code_information":[{"code":"308","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11407.19,"maximum":21033.85,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15977.09},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11407.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11407.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15552.67},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":16036.85},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16833.48},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11407.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11407.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":18297.26},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11407.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11407.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11407.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11407.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11407.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11407.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11407.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21033.85},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19212.79},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11407.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16173.35,"10th_percentile":16173.35,"90th_percentile":16173.35,"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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":23126.08,"10th_percentile":23126.08,"90th_percentile":23126.08,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9525.34,"10th_percentile":7802.04,"90th_percentile":9847.21,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21458.56,"10th_percentile":10809.27,"90th_percentile":70208.18,"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":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9567.34,"10th_percentile":9107.63,"90th_percentile":9995.75,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9239.58,"10th_percentile":9239.58,"90th_percentile":9239.58,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":55132.97,"10th_percentile":35982.11,"90th_percentile":61775.5,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":10004.98,"10th_percentile":10004.98,"90th_percentile":10004.98},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8596.33,"10th_percentile":8596.33,"90th_percentile":8596.33,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"15","median_amount":9449.29,"10th_percentile":8370.44,"90th_percentile":9711.27,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":6874.02,"10th_percentile":6657.71,"90th_percentile":28610.97,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7297.89,"10th_percentile":7297.89,"90th_percentile":7297.89,"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":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":21032.1,"10th_percentile":21032.1,"90th_percentile":21032.1,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9527.05,"10th_percentile":9517.05,"90th_percentile":9812.22,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Congenital And Valvular Disorders Without Mcc","code_information":[{"code":"307","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8779.4,"maximum":16155.6,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12271.62},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8779.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8779.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11945.64},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":12317.52},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12929.4},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8779.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8779.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":14053.69},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8779.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8779.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8779.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8779.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8779.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8779.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8779.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16155.6},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14756.89},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8779.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7412.15,"10th_percentile":7412.15,"90th_percentile":7412.15,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":972.48,"10th_percentile":972.48,"90th_percentile":972.48,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":2901.34,"10th_percentile":2901.34,"90th_percentile":2901.34,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8418.96,"10th_percentile":8418.96,"90th_percentile":8418.96,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Congenital And Valvular Disorders With Mcc","code_information":[{"code":"306","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14766.94,"maximum":26116.15,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19837.56},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14766.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14766.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19310.59},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":19911.75},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20900.87},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14766.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14766.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":22718.34},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14766.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14766.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14766.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14766.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14766.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14766.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14766.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26116.15},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23855.08},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14766.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":9806.93,"10th_percentile":9806.93,"90th_percentile":9806.93,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11738.46,"10th_percentile":11738.46,"90th_percentile":11738.46,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":29866.26,"10th_percentile":29866.26,"90th_percentile":29866.26,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":9806.93,"10th_percentile":9806.93,"90th_percentile":9806.93,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10706.4,"10th_percentile":10706.4,"90th_percentile":10706.4,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":13372.27,"10th_percentile":13372.27,"90th_percentile":13372.27,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":6379.94,"10th_percentile":6379.94,"90th_percentile":6379.94,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10946.91,"10th_percentile":10946.91,"90th_percentile":10946.91,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10611.32,"10th_percentile":4547.93,"90th_percentile":11734.49,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11861.36,"10th_percentile":11860.16,"90th_percentile":11861.36,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":168.28,"10th_percentile":168.28,"90th_percentile":168.28,"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":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11726.48,"10th_percentile":9911.7,"90th_percentile":12684.68,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertension Without Mcc","code_information":[{"code":"305","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7350.74,"maximum":13092.96,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9945.27},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7350.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7350.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9681.09},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":9982.47},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10478.35},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7350.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7350.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11389.52},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7350.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7350.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7350.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7350.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7350.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7350.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7350.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13092.96},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11959.4},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7350.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7083.99,"10th_percentile":7083.99,"90th_percentile":7083.99,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6085.24,"10th_percentile":6085.24,"90th_percentile":6085.24,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":37082.32,"10th_percentile":37082.32,"90th_percentile":37082.32,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":4304.39,"10th_percentile":4304.39,"90th_percentile":4304.39,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6085.52,"10th_percentile":6085.52,"90th_percentile":6085.52,"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":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":52502.5,"10th_percentile":52502.5,"90th_percentile":52502.5,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":5613.58,"10th_percentile":5613.58,"90th_percentile":5613.58},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":3554.18,"10th_percentile":3554.18,"90th_percentile":3554.18,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5686.85,"10th_percentile":983.6,"90th_percentile":6351.58,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":3998.6,"10th_percentile":3998.6,"90th_percentile":3998.6,"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 Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5572.3,"10th_percentile":236.42,"90th_percentile":6346.5,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertension With Mcc","code_information":[{"code":"304","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11280.68,"maximum":20489.69,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15563.75},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11280.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11280.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15150.31},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":15621.96},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16397.99},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11280.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11280.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":17823.9},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11280.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11280.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11280.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11280.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11280.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11280.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11280.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20489.69},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18715.74},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11280.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":64543.53,"10th_percentile":64543.53,"90th_percentile":64543.53,"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":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":37831.08,"10th_percentile":37831.08,"90th_percentile":57003.7,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11359.87,"10th_percentile":11359.87,"90th_percentile":11359.87,"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":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":8482.86,"10th_percentile":8482.86,"90th_percentile":8482.86,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7067.33,"10th_percentile":7067.33,"90th_percentile":7067.33,"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":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":20489.69,"10th_percentile":20489.69,"90th_percentile":20489.69,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7881.33,"10th_percentile":7881.33,"90th_percentile":7881.33,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Atherosclerosis Without Mcc","code_information":[{"code":"303","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6610.65,"maximum":11727.33,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8907.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6610.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6610.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8671.32},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":8941.27},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9385.43},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6610.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6610.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10201.56},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6610.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6610.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6610.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6610.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6610.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6610.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6610.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11727.33},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10712.0},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6610.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2855.82,"10th_percentile":2855.82,"90th_percentile":2855.82,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":34617.91,"10th_percentile":34617.91,"90th_percentile":34617.91,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":18185.52,"10th_percentile":18185.52,"90th_percentile":18185.52,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5475.94,"10th_percentile":5475.94,"90th_percentile":5475.94,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Atherosclerosis With Mcc","code_information":[{"code":"302","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11340.32,"maximum":20287.37,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15410.07},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11340.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11340.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15000.72},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":15467.71},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16236.07},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11340.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11340.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":17647.91},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11340.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11340.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11340.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11340.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11340.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11340.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11340.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20287.37},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18530.94},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11340.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9194.36,"10th_percentile":9194.36,"90th_percentile":9194.36,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":33543.32,"10th_percentile":33543.32,"90th_percentile":33543.32,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8621.06,"10th_percentile":8621.06,"90th_percentile":9011.28,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":11041.37,"10th_percentile":11041.37,"90th_percentile":11041.37,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":166.2,"10th_percentile":166.2,"90th_percentile":166.2,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral Vascular Disorders Without Cc/Mcc","code_information":[{"code":"301","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7030.85,"maximum":12440.67,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9449.8},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7030.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7030.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9198.77},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":9485.14},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9956.32},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7030.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7030.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10822.09},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7030.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7030.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7030.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7030.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7030.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7030.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7030.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12440.67},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11363.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7030.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":1069.36,"10th_percentile":1069.36,"90th_percentile":1069.36,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26672.42,"10th_percentile":26672.42,"90th_percentile":26672.42,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":24972.12,"10th_percentile":24972.12,"90th_percentile":36144.64,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5012.29,"10th_percentile":5012.29,"90th_percentile":5012.29,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":33479.22,"10th_percentile":19903.74,"90th_percentile":56665.53,"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":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":64692.52,"10th_percentile":64692.52,"90th_percentile":66913.78,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":13964.3,"10th_percentile":13964.3,"90th_percentile":13964.3},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12848.58,"10th_percentile":12848.58,"90th_percentile":12848.58,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":5354.56,"10th_percentile":4456.83,"90th_percentile":17434.48,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6294.8,"10th_percentile":6294.8,"90th_percentile":6294.8,"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 Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","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":"1 through 10","median_amount":6090.67,"10th_percentile":6090.67,"90th_percentile":6090.67,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":53412.79,"10th_percentile":53412.79,"90th_percentile":57563.4,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":52424.43,"10th_percentile":52424.43,"90th_percentile":52424.43,"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":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":4054.75,"10th_percentile":4054.75,"90th_percentile":4054.75,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12654.76,"10th_percentile":12654.76,"90th_percentile":12654.76,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":31806.95,"10th_percentile":21869.29,"90th_percentile":206456.68,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":8917.97,"10th_percentile":8917.97,"90th_percentile":8966.37},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":5900.12,"10th_percentile":5900.12,"90th_percentile":5900.12,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12646.69,"10th_percentile":12639.46,"90th_percentile":12646.69,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":10941.57,"10th_percentile":10941.57,"90th_percentile":10941.57,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10682.17,"10th_percentile":10682.17,"90th_percentile":10682.17,"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 Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6686.03,"10th_percentile":6686.03,"90th_percentile":6686.03,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrest, Unexplained Without Cc/Mcc","code_information":[{"code":"298","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4639.81,"maximum":7701.95,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5850.32},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4639.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4639.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5694.91},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":5872.2},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6163.9},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4639.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4639.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":6699.89},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4639.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4639.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4639.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4639.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4639.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4639.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4639.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7701.95},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7035.13},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4639.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrest, Unexplained With Cc","code_information":[{"code":"297","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6256.43,"maximum":12285.44,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9331.89},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6256.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6256.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9084.0},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":9366.79},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9832.09},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6256.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6256.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10687.06},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6256.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6256.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6256.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6256.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6256.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6256.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6256.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12285.44},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11221.8},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6256.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrest, Unexplained With Mcc","code_information":[{"code":"296","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14641.33,"maximum":28573.59,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21704.2},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14641.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14641.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21127.65},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":21785.38},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22867.57},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14641.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14641.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":24856.06},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14641.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14641.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14641.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14641.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14641.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14641.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14641.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28573.59},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26099.76},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14641.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":10610.2,"10th_percentile":10610.2,"90th_percentile":10610.2,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10504.39,"10th_percentile":10504.39,"90th_percentile":10504.39,"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":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Deep Vein Thrombophlebitis Without Cc/Mcc","code_information":[{"code":"295","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10185.32,"maximum":13774.9,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10463.27},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10185.32},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":10502.4},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11024.12},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11982.74},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13774.9},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12582.3}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Deep Vein Thrombophlebitis With Cc/Mcc","code_information":[{"code":"294","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15835.1,"maximum":21415.8,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16267.22},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15835.1},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":16328.06},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17139.16},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":18629.53},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21415.8},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19561.67}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10811.34,"10th_percentile":10811.34,"90th_percentile":10811.34,"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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Failure And Shock Without Cc/Mcc","code_information":[{"code":"293","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5641.95,"maximum":9575.11,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7273.15},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5641.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5641.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7079.95},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":7300.35},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7663.0},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5641.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5641.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":8329.35},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5641.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5641.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5641.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5641.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5641.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5641.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5641.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9575.11},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8746.12},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5641.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":3737.4,"10th_percentile":3737.4,"90th_percentile":3737.4,"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":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Failure And Shock With Cc","code_information":[{"code":"292","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8199.26,"maximum":15021.93,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11410.5},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8199.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8199.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11107.39},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11453.18},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12022.12},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8199.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8199.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":13067.52},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8199.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8199.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8199.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8199.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8199.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8199.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8199.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15021.93},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13721.37},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8199.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11409.18,"10th_percentile":11409.18,"90th_percentile":11409.18,"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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":5052.04,"10th_percentile":5052.04,"90th_percentile":5052.04,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":3696.83,"10th_percentile":1539.48,"90th_percentile":7071.45,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":30679.34,"10th_percentile":30679.34,"90th_percentile":30679.34,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":51365.7,"10th_percentile":51365.7,"90th_percentile":51365.7,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":4824.84,"10th_percentile":4824.84,"90th_percentile":4824.84,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1123.25,"10th_percentile":1123.25,"90th_percentile":1123.25,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":31186.33,"10th_percentile":31186.33,"90th_percentile":58620.19,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":13135.97,"10th_percentile":13135.97,"90th_percentile":13135.97},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7071.45,"10th_percentile":7071.45,"90th_percentile":7071.45,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5345.2,"10th_percentile":5345.2,"90th_percentile":5345.2,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":5235.19,"10th_percentile":5235.19,"90th_percentile":5702.65,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4742.35,"10th_percentile":4742.35,"90th_percentile":4742.35,"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":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":254.43,"10th_percentile":254.43,"90th_percentile":254.43,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6936.06,"10th_percentile":6936.06,"90th_percentile":6936.06,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Failure And Shock With Mcc","code_information":[{"code":"291","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12128.3,"maximum":22758.76,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17287.32},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12128.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12128.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16828.09},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":17351.97},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18213.94},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12128.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12128.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":19797.76},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12128.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12128.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12128.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12128.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12128.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12128.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12128.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22758.76},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20788.36},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12128.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17285.99,"10th_percentile":16807.87,"90th_percentile":27177.64,"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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient 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":6573.09,"10th_percentile":5556.6,"90th_percentile":10059.03,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"36","median_amount":10266.2,"10th_percentile":7397.08,"90th_percentile":10303.18,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":50470.04,"10th_percentile":46026.33,"90th_percentile":78973.19,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"12","median_amount":49020.16,"10th_percentile":25431.43,"90th_percentile":66550.03,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":7451.9,"10th_percentile":6573.09,"90th_percentile":9829.88,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"13","median_amount":10275.18,"10th_percentile":9041.2,"90th_percentile":10428.31,"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":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9966.92,"10th_percentile":9958.21,"90th_percentile":9966.92,"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":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"20","median_amount":41951.29,"10th_percentile":26853.3,"90th_percentile":75213.06,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9683.8,"10th_percentile":9589.52,"90th_percentile":10313.1,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11640.32,"10th_percentile":11640.32,"90th_percentile":11640.32,"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":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient 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":4843.5,"10th_percentile":4391.46,"90th_percentile":6573.09,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8429.98,"10th_percentile":8429.98,"90th_percentile":9256.95,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"54","median_amount":10185.18,"10th_percentile":7556.49,"90th_percentile":10429.42,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10381.66,"10th_percentile":8743.44,"90th_percentile":10385.92,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8631.91,"10th_percentile":8631.91,"90th_percentile":8631.91,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient 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":6573.09,"10th_percentile":5235.19,"90th_percentile":9829.88,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8031.14,"10th_percentile":8031.14,"90th_percentile":9570.07,"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":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":28805.81,"10th_percentile":28805.81,"90th_percentile":28805.81,"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":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":21751.2,"10th_percentile":21751.2,"90th_percentile":21751.2,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"84","median_amount":9993.67,"10th_percentile":8306.2,"90th_percentile":10428.31,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute And Subacute Endocarditis Without Cc/Mcc","code_information":[{"code":"290","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8928.5,"maximum":17074.74,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12969.79},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8928.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8928.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12625.26},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":13018.3},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13664.99},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8928.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8928.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":14853.25},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8928.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8928.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8928.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8928.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8928.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8928.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8928.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17074.74},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15596.45},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8928.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":53344.42,"10th_percentile":53344.42,"90th_percentile":53344.42,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute And Subacute Endocarditis With Cc","code_information":[{"code":"289","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15951.61,"maximum":27497.48,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20886.8},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15951.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15951.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20331.96},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":20964.92},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22006.36},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15951.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15951.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":23919.95},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15951.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15951.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15951.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15951.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15951.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15951.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15951.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27497.48},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25116.81},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15951.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":146273.47,"10th_percentile":146273.47,"90th_percentile":146273.47,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12335.67,"10th_percentile":12335.67,"90th_percentile":12335.67,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute And Subacute Endocarditis With Mcc","code_information":[{"code":"288","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24981.72,"maximum":47636.6,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36184.26},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24981.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24981.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35223.06},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":36319.6},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38123.79},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24981.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24981.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":41438.9},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24981.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24981.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24981.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24981.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24981.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24981.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24981.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47636.6},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43512.34},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24981.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":8007.68,"10th_percentile":8007.68,"90th_percentile":8007.68,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8642.87,"10th_percentile":8639.24,"90th_percentile":8662.61,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":56576.18,"10th_percentile":56576.18,"90th_percentile":56576.18,"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":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":53823.03,"10th_percentile":46187.42,"90th_percentile":55510.54,"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":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":7779.11,"10th_percentile":7779.11,"90th_percentile":7779.11,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9807.79,"10th_percentile":9807.79,"90th_percentile":15776.7,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8377.77,"10th_percentile":8377.77,"90th_percentile":8377.77,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"22","median_amount":46566.87,"10th_percentile":41469.33,"90th_percentile":72218.79,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":16280.83,"10th_percentile":16280.83,"90th_percentile":22766.88},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":8081.15,"10th_percentile":8081.15,"90th_percentile":8081.15,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2974.03,"10th_percentile":2974.03,"90th_percentile":2974.03,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"13","median_amount":8087.47,"10th_percentile":6874.44,"90th_percentile":8652.47,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":9379.76,"10th_percentile":9379.76,"90th_percentile":9379.76,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":6182.85,"10th_percentile":6182.85,"90th_percentile":6182.85,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":19005.46,"10th_percentile":18663.61,"90th_percentile":19005.46,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8803.43,"10th_percentile":6814.07,"90th_percentile":9469.87,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc","code_information":[{"code":"286","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20523.14,"maximum":38602.17,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29321.8},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20523.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20523.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28542.89},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":29431.47},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30893.48},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20523.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20523.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":33579.88},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20523.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20523.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20523.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20523.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20523.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20523.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20523.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38602.17},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35260.08},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20523.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":29321.8,"10th_percentile":29321.8,"90th_percentile":29321.8,"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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":11926.22,"10th_percentile":11926.22,"90th_percentile":12805.03,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16839.73,"10th_percentile":16559.81,"90th_percentile":17199.74,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":53936.63,"10th_percentile":53936.63,"90th_percentile":635541.59,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":90580.74,"10th_percentile":61753.43,"90th_percentile":240429.49,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":11926.22,"10th_percentile":11926.22,"90th_percentile":75581.63,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16575.05,"10th_percentile":14795.81,"90th_percentile":17600.58,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":65097.6,"10th_percentile":65097.6,"90th_percentile":65097.6,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"12","median_amount":66459.55,"10th_percentile":53984.52,"90th_percentile":99005.55,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":23859.59,"10th_percentile":23859.59,"90th_percentile":23859.59},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16867.73,"10th_percentile":16867.73,"90th_percentile":16867.73,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":11666.41,"10th_percentile":11666.41,"90th_percentile":11666.41,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14491.25,"10th_percentile":14491.25,"90th_percentile":14491.25,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"15","median_amount":16826.38,"10th_percentile":14280.86,"90th_percentile":17600.58,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24866.96,"10th_percentile":24866.96,"90th_percentile":24866.96,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15958.1,"10th_percentile":15958.1,"90th_percentile":15958.1,"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":8578.68,"10th_percentile":8500.95,"90th_percentile":11848.49,"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":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16442.63,"10th_percentile":14766.63,"90th_percentile":16442.63,"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":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":36851.44,"10th_percentile":34119.91,"90th_percentile":38602.17,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"1 through 10","median_amount":35260.08,"10th_percentile":35260.08,"90th_percentile":35260.08,"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":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"13","median_amount":17149.82,"10th_percentile":15325.02,"90th_percentile":17233.09,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Expired Without Cc/Mcc","code_information":[{"code":"285","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5939.25,"maximum":9789.63,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7436.1},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5939.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5939.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7238.57},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":7463.91},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7834.69},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5939.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5939.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":8515.97},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5939.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5939.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5939.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5939.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5939.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5939.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5939.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9789.63},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8942.07},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5939.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Expired With Cc","code_information":[{"code":"284","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6782.35,"maximum":12922.04,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9815.44},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6782.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6782.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9554.71},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":9852.15},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10341.56},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6782.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6782.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11240.83},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6782.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6782.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6782.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6782.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6782.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6782.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6782.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12922.04},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11803.28},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6782.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Expired With Mcc","code_information":[{"code":"283","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18426.69,"maximum":34104.13,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25905.14},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18426.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18426.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25216.99},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":26002.03},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27293.69},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18426.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18426.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":29667.06},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18426.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18426.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18426.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18426.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18426.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18426.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18426.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34104.13},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31151.48},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18426.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":32243.48,"10th_percentile":32243.48,"90th_percentile":32243.48,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15194.29,"10th_percentile":15194.29,"90th_percentile":15194.29,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15207.76,"10th_percentile":15207.76,"90th_percentile":15207.76,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":344316.78,"10th_percentile":344316.78,"90th_percentile":344316.78,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":15702.8,"10th_percentile":15702.8,"90th_percentile":15702.8},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15194.29,"10th_percentile":14432.38,"90th_percentile":15207.75,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":543.79,"10th_percentile":543.79,"90th_percentile":543.79,"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":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":34104.13,"10th_percentile":34104.13,"90th_percentile":34104.13,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15809.45,"10th_percentile":15809.45,"90th_percentile":15809.45,"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":"Youthcare","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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5894.11,"10th_percentile":5894.11,"90th_percentile":6102.35,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":48644.07,"10th_percentile":48644.07,"90th_percentile":48644.07,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":42114.35,"10th_percentile":30993.0,"90th_percentile":51812.88,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6021.46,"10th_percentile":6021.46,"90th_percentile":6099.46,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":6237.32,"10th_percentile":6237.32,"90th_percentile":6237.32,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":3748.84,"10th_percentile":3748.84,"90th_percentile":3748.84,"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 Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"1 through 10","median_amount":11551.57,"10th_percentile":11551.57,"90th_percentile":11551.57,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Discharged Alive With Cc","code_information":[{"code":"281","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8832.71,"maximum":16077.11,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12212.01},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8832.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8832.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11887.61},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":12257.68},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12866.59},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8832.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8832.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":13985.42},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8832.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8832.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8832.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8832.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8832.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8832.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8832.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16077.11},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14685.2},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8832.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":6055.13,"10th_percentile":6055.13,"90th_percentile":6055.13,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"13","median_amount":7024.65,"10th_percentile":5880.11,"90th_percentile":7375.41,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":21121.96,"10th_percentile":21121.96,"90th_percentile":21121.96,"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":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":31851.06,"10th_percentile":31851.06,"90th_percentile":31851.06,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":6237.32,"10th_percentile":6237.32,"90th_percentile":6237.32,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7384.61,"10th_percentile":7384.61,"90th_percentile":7384.61,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":44329.79,"10th_percentile":28608.56,"90th_percentile":55865.62,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":16756.57,"10th_percentile":16756.57,"90th_percentile":16756.57},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7612.65,"10th_percentile":6196.72,"90th_percentile":7636.35,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":5625.09,"10th_percentile":5625.09,"90th_percentile":26074.71,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":12861.69,"10th_percentile":12861.69,"90th_percentile":12861.69,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5548.62,"10th_percentile":285.67,"90th_percentile":7612.65,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Discharged Alive With Mcc","code_information":[{"code":"280","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15022.67,"maximum":28629.4,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21746.59},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15022.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15022.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21168.92},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":21827.93},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22912.24},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15022.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15022.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":24904.61},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15022.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15022.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15022.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15022.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15022.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15022.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15022.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28629.4},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26150.74},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15022.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":7835.19,"10th_percentile":6888.75,"90th_percentile":18878.97,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"24","median_amount":12815.79,"10th_percentile":7389.06,"90th_percentile":12901.17,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11178.61,"10th_percentile":11178.61,"90th_percentile":12584.57,"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":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":38862.86,"10th_percentile":26359.64,"90th_percentile":134332.03,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":38374.91,"10th_percentile":38374.91,"90th_percentile":38374.91,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"1 through 10","median_amount":204188.84,"10th_percentile":204188.84,"90th_percentile":204188.84,"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":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":30894.26,"10th_percentile":30894.26,"90th_percentile":30894.26,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12439.43,"10th_percentile":12439.43,"90th_percentile":12439.43,"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":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12442.32,"10th_percentile":12431.36,"90th_percentile":12442.32,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"11","median_amount":64827.4,"10th_percentile":37602.7,"90th_percentile":80999.08,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":32813.41,"10th_percentile":32813.41,"90th_percentile":32813.41},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":6573.09,"10th_percentile":5450.43,"90th_percentile":24111.11,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"17","median_amount":10272.77,"10th_percentile":6911.99,"90th_percentile":12831.83,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12656.38,"10th_percentile":12656.38,"90th_percentile":17799.92,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12978.93,"10th_percentile":12978.93,"90th_percentile":12978.93,"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":"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":"12","median_amount":10124.16,"10th_percentile":7116.13,"90th_percentile":32779.44,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16256.16,"10th_percentile":16256.16,"90th_percentile":16256.16,"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 Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":5537.89,"10th_percentile":5537.89,"90th_percentile":5537.89,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":40249.79,"10th_percentile":26565.24,"90th_percentile":96770.56,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"18","median_amount":12526.58,"10th_percentile":7851.27,"90th_percentile":12835.43,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":33116.31,"maximum":55884.45,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42449.24},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33116.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33116.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41321.62},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":42608.01},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44724.58},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33116.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33116.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":48613.67},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33116.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33116.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33116.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33116.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33116.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33116.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33116.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55884.45},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":51046.11},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33116.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":16163.45,"10th_percentile":16163.45,"90th_percentile":16163.45,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":22391.83,"10th_percentile":22391.83,"90th_percentile":22391.83,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures With Mcc","code_information":[{"code":"278","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":50825.91,"maximum":87255.58,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66278.42},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50825.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50825.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":64517.8},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":66526.31},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":69831.03},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50825.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50825.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":75903.3},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50825.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50825.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50825.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50825.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50825.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50825.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50825.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":87255.58},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":79701.2},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50825.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":180713.73,"10th_percentile":180713.73,"90th_percentile":180713.73,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":20879.13,"10th_percentile":20879.13,"90th_percentile":20879.13,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24493.19,"10th_percentile":24493.19,"90th_percentile":24493.19,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant Without Mcc","code_information":[{"code":"277","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":42262.08,"maximum":81139.02,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61632.35},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42262.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42262.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":59995.14},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":61862.86},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":64935.92},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42262.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42262.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":70582.53},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42262.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42262.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42262.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42262.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42262.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42262.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42262.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":81139.02},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":74114.2},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42262.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":35651.55,"10th_percentile":35651.55,"90th_percentile":35651.55,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":170322.96,"10th_percentile":170322.96,"90th_percentile":170322.96,"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":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":35633.15,"10th_percentile":35633.15,"90th_percentile":35633.15,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator","code_information":[{"code":"276","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":54805.55,"maximum":108029.55,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":82058.11},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54805.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54805.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":79878.32},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":82365.02},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":86456.53},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54805.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54805.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":93974.5},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54805.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54805.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54805.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54805.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54805.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54805.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54805.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":108029.55},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":98676.61},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54805.55,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":131598.65,"10th_percentile":131598.65,"90th_percentile":131598.65,"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":"Aetna","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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":177284.42,"10th_percentile":177284.42,"90th_percentile":177284.42,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc","code_information":[{"code":"275","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":64960.69,"maximum":123246.83,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":93616.99},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64960.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64960.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":91130.15},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":93967.14},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":98634.98},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64960.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64960.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":107211.95},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64960.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64960.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64960.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64960.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64960.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64960.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64960.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":123246.83},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":112576.41},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64960.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":53913.19,"10th_percentile":53913.19,"90th_percentile":53913.19,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":250006.11,"10th_percentile":250006.11,"90th_percentile":250006.11,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":51590.59,"10th_percentile":51590.59,"90th_percentile":51590.59,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous And Other Intracardiac Procedures Without Mcc","code_information":[{"code":"274","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30272.55,"maximum":54429.87,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41344.36},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30272.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30272.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40246.09},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":41498.99},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43560.47},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30272.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30272.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":47348.34},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30272.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30272.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30272.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30272.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30272.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30272.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30272.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54429.87},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":49717.46},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30272.55,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":15875.03,"10th_percentile":15875.03,"90th_percentile":15875.03,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"22","median_amount":24056.12,"10th_percentile":24023.39,"90th_percentile":25930.21,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":97222.25,"10th_percentile":97222.25,"90th_percentile":97222.25,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":15050.8,"10th_percentile":15050.8,"90th_percentile":15050.8,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25685.21,"10th_percentile":25685.21,"90th_percentile":25930.21,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":132423.23,"10th_percentile":121596.95,"90th_percentile":179893.92,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21650.38,"10th_percentile":21650.38,"90th_percentile":21650.38,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"17","median_amount":24027.29,"10th_percentile":23337.13,"90th_percentile":25934.11,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24332.64,"10th_percentile":24332.64,"90th_percentile":24332.64,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":15488.34,"10th_percentile":15488.34,"90th_percentile":15488.34,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21496.2,"10th_percentile":21496.2,"90th_percentile":21496.2,"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 Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":54433.36,"10th_percentile":54433.36,"90th_percentile":54433.36,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"12","median_amount":24023.39,"10th_percentile":23812.7,"90th_percentile":29453.08,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous And Other Intracardiac Procedures With Mcc","code_information":[{"code":"273","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":37807.12,"maximum":68194.31,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51799.68},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37807.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37807.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":50423.67},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":51993.42},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":54576.21},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37807.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37807.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":59321.97},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37807.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37807.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37807.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37807.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37807.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37807.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37807.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":68194.31},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":62290.21},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37807.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":36315.74,"10th_percentile":36315.74,"90th_percentile":36315.74,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":157719.52,"10th_percentile":157719.52,"90th_percentile":157719.52,"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":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":29128.17,"10th_percentile":29128.17,"90th_percentile":29128.17,"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":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":328985.87,"10th_percentile":328985.87,"90th_percentile":328985.87,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30026.69,"10th_percentile":30014.66,"90th_percentile":32389.56,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27391.09,"10th_percentile":27391.09,"90th_percentile":27391.09,"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 Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":71952.85,"10th_percentile":71952.85,"90th_percentile":71952.85,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":29555.2,"10th_percentile":29555.2,"90th_percentile":29555.2,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Major Cardiovascular Procedures Without Cc/Mcc","code_information":[{"code":"272","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23597.34,"maximum":43637.38,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33146.5},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23597.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23597.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32265.99},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":33270.47},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34923.19},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23597.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23597.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":37959.99},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23597.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23597.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23597.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23597.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23597.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23597.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23597.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43637.38},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39859.36},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23597.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":98369.26,"10th_percentile":98369.26,"90th_percentile":98369.26,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":163752.57,"10th_percentile":132804.96,"90th_percentile":266763.79,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19351.96,"10th_percentile":19351.96,"90th_percentile":19351.96,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Major Cardiovascular Procedures With Cc","code_information":[{"code":"271","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32663.59,"maximum":60073.78,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45631.41},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32663.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32663.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44419.26},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":45802.08},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":48077.31},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32663.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32663.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":52257.95},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32663.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32663.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32663.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32663.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32663.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32663.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32663.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60073.78},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":54872.74},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32663.59,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":42840.15,"10th_percentile":42840.15,"90th_percentile":45631.41,"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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":30053.76,"10th_percentile":30053.76,"90th_percentile":30053.76,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":29096.57,"10th_percentile":19351.88,"90th_percentile":50110.44,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":163289.56,"10th_percentile":163289.56,"90th_percentile":163289.56,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":94150.33,"10th_percentile":94150.33,"90th_percentile":94150.33,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":24932.38,"10th_percentile":23120.63,"90th_percentile":43530.28,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26473.04,"10th_percentile":26473.04,"90th_percentile":26473.04,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":98706.19,"10th_percentile":70692.42,"90th_percentile":190480.53,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":32380.72,"10th_percentile":32380.72,"90th_percentile":32380.72},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":22908.72,"10th_percentile":22908.72,"90th_percentile":22908.72,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24906.24,"10th_percentile":24906.24,"90th_percentile":24906.24,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25156.98,"10th_percentile":25156.98,"90th_percentile":27980.94,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25122.81,"10th_percentile":25122.81,"90th_percentile":25122.81,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":16623.39,"10th_percentile":16623.39,"90th_percentile":16623.39,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24830.55,"10th_percentile":24830.55,"90th_percentile":24830.55,"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 Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":18246.16,"10th_percentile":18246.16,"90th_percentile":18246.16,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":60073.78,"10th_percentile":60073.78,"90th_percentile":60073.78,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26496.76,"10th_percentile":26473.05,"90th_percentile":26496.76,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Major Cardiovascular Procedures With Mcc","code_information":[{"code":"270","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":48206.24,"maximum":89521.16,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67999.33},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48206.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48206.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":66193.0},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":68253.66},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":71644.19},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48206.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48206.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":77874.12},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48206.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48206.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48206.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48206.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48206.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48206.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48206.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":89521.16},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":81770.64},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48206.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":39311.67,"10th_percentile":39305.68,"90th_percentile":39348.06,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":165783.43,"10th_percentile":69208.75,"90th_percentile":308076.29,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":101098.81,"10th_percentile":101098.81,"90th_percentile":101098.81,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":36582.32,"10th_percentile":36582.32,"90th_percentile":36582.32,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":41089.57,"10th_percentile":41089.57,"90th_percentile":41089.57,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":197182.49,"10th_percentile":95111.53,"90th_percentile":257223.9,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":27347.53,"10th_percentile":27347.53,"90th_percentile":27347.53,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"15","median_amount":38648.36,"10th_percentile":37891.71,"90th_percentile":41252.22,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":66954.75,"10th_percentile":66954.75,"90th_percentile":66954.75,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":27001.63,"10th_percentile":27001.63,"90th_percentile":77500.14,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":46965.0,"10th_percentile":46965.0,"90th_percentile":46965.0,"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":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":60073.78,"10th_percentile":60073.78,"90th_percentile":60073.78,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":39299.06,"10th_percentile":37328.21,"90th_percentile":54935.11,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc","code_information":[{"code":"269","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":38689.98,"maximum":72561.54,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55116.98},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38689.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38689.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":53652.85},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":55323.13},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":58071.32},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38689.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38689.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":63121.01},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38689.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38689.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38689.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38689.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38689.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38689.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38689.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":72561.54},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":66279.33},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38689.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":31913.45,"10th_percentile":31906.69,"90th_percentile":31932.46,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":148430.28,"10th_percentile":148430.28,"90th_percentile":148430.28,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":122756.99,"10th_percentile":122756.99,"90th_percentile":122756.99,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":25684.39,"10th_percentile":25684.39,"90th_percentile":25684.39,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":31867.4,"10th_percentile":31867.4,"90th_percentile":31867.4,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30941.84,"10th_percentile":30941.84,"90th_percentile":30941.84,"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":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":139702.22,"10th_percentile":139702.22,"90th_percentile":139702.22,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":19487.06,"10th_percentile":19487.06,"90th_percentile":19487.06},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":32705.3,"10th_percentile":31902.7,"90th_percentile":36800.53,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc","code_information":[{"code":"268","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":62678.99,"maximum":116282.64,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":88327.07},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62678.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62678.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":85980.74},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":88657.43},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":93061.51},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62678.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62678.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":101153.82},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62678.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62678.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62678.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62678.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62678.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62678.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62678.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":116282.64},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":106215.16},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62678.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":50933.77,"10th_percentile":50933.77,"90th_percentile":50933.77,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":304431.32,"10th_percentile":304431.32,"90th_percentile":304431.32,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":48189.77,"10th_percentile":48189.77,"90th_percentile":48189.77,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":33925.63,"10th_percentile":33925.63,"90th_percentile":33925.63,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":62841.55,"10th_percentile":62841.55,"90th_percentile":62841.55,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":49858.9,"10th_percentile":49858.9,"90th_percentile":50897.86,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":43547.97,"maximum":82049.44,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62323.89},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43547.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43547.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":60668.32},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":62556.99},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":65664.53},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43547.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43547.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":71374.5},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43547.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43547.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43547.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43547.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43547.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43547.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43547.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":82049.44},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":74945.8},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43547.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":60852.77,"10th_percentile":60852.77,"90th_percentile":60852.77,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":34598.5,"10th_percentile":34200.55,"90th_percentile":37602.76,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"29","median_amount":36978.32,"10th_percentile":36023.46,"90th_percentile":37406.01,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":200081.57,"10th_percentile":200081.57,"90th_percentile":200081.57,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":221272.17,"10th_percentile":221272.17,"90th_percentile":221272.17,"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":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":31679.98,"10th_percentile":31679.98,"90th_percentile":31679.98,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":36025.86,"10th_percentile":36025.36,"90th_percentile":36929.32,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":225099.06,"10th_percentile":97356.2,"90th_percentile":234033.62,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":78902.15,"10th_percentile":78902.15,"90th_percentile":78902.15},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":37279.02,"10th_percentile":37279.02,"90th_percentile":37279.02,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":10129.0,"10th_percentile":10129.0,"90th_percentile":10129.0,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"32","median_amount":36055.74,"10th_percentile":35985.86,"90th_percentile":37276.22,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":41939.83,"10th_percentile":41939.83,"90th_percentile":41939.83,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":39420.7,"10th_percentile":39420.7,"90th_percentile":39420.7,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":83033.11,"10th_percentile":83033.11,"90th_percentile":83033.11,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"30","median_amount":36051.84,"10th_percentile":35821.54,"90th_percentile":37272.33,"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":"Youthcare","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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":72756.32,"10th_percentile":72756.32,"90th_percentile":72756.32,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"11","median_amount":45761.3,"10th_percentile":36049.03,"90th_percentile":53749.65,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":264578.82,"10th_percentile":264578.82,"90th_percentile":264578.82,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":60615.01,"10th_percentile":60615.01,"90th_percentile":60615.01,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":414285.75,"10th_percentile":414285.75,"90th_percentile":414285.75,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":37272.32,"10th_percentile":36051.84,"90th_percentile":47837.41,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":46359.78,"10th_percentile":46359.78,"90th_percentile":46359.78,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":50609.2,"10th_percentile":35826.05,"90th_percentile":151844.14,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":70422.57,"10th_percentile":70422.57,"90th_percentile":70422.57,"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":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":45516.3,"10th_percentile":45516.3,"90th_percentile":45763.8,"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":"Youthcare","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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26543.64,"10th_percentile":26543.64,"90th_percentile":26543.64,"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":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Circulatory System O.R. Procedures","code_information":[{"code":"264","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30714.43,"maximum":60954.55,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46300.44},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30714.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30714.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":45070.51},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":46473.61},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":48782.2},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30714.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30714.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":53024.13},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30714.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30714.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30714.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30714.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30714.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30714.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30714.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60954.55},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":55677.25},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30714.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26869.43,"10th_percentile":26869.43,"90th_percentile":52907.04,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":190.55,"10th_percentile":190.55,"90th_percentile":190.55,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":101453.57,"10th_percentile":101453.57,"90th_percentile":112890.38,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":24241.87,"10th_percentile":24241.87,"90th_percentile":24241.87},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26560.43,"10th_percentile":26560.43,"90th_percentile":26857.61,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26122.09,"10th_percentile":26082.89,"90th_percentile":26893.49,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":28155.31,"maximum":46775.02,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35529.81},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28155.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28155.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34586.0},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":35662.7},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37434.26},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28155.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28155.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":40689.41},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28155.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28155.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28155.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28155.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28155.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28155.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28155.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46775.02},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":42725.35},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28155.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":73819.9,"10th_percentile":73819.9,"90th_percentile":73819.9,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Revision Except Device Replacement Without Cc/Mcc","code_information":[{"code":"262","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15255.81,"maximum":26470.21,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20106.49},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15255.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15255.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19572.38},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":20181.69},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21184.22},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15255.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15255.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":23026.33},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15255.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15255.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15255.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15255.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15255.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15255.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15255.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26470.21},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24178.48},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15255.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11133.76,"10th_percentile":11133.76,"90th_percentile":11133.76,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Revision Except Device Replacement With Cc","code_information":[{"code":"261","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17610.7,"maximum":33092.55,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25136.76},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17610.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17610.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24469.02},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":25230.77},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26484.12},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17610.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17610.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":28787.09},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17610.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17610.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17610.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17610.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17610.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17610.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17610.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33092.55},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30227.48},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17610.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13936.29,"10th_percentile":13936.29,"90th_percentile":13936.29,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11840.98,"10th_percentile":11840.98,"90th_percentile":11840.98,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12469.19,"10th_percentile":12469.19,"90th_percentile":12469.19,"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 Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Revision Except Device Replacement With Mcc","code_information":[{"code":"260","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29921.03,"maximum":59418.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45133.29},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29921.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29921.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43934.37},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":45302.09},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":47552.49},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29921.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29921.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":51687.49},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29921.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29921.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29921.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29921.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29921.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29921.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29921.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59418.0},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":54273.73},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29921.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26682.96,"10th_percentile":26682.96,"90th_percentile":26682.96,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":114186.35,"10th_percentile":114186.35,"90th_percentile":114186.35,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Device Replacement Without Mcc","code_information":[{"code":"259","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18799.89,"maximum":30654.3,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23284.68},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18799.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18799.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22666.15},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":23371.77},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24532.77},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18799.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18799.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":26666.06},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18799.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18799.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18799.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18799.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18799.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18799.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18799.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30654.3},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28000.33},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18799.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Device Replacement With Mcc","code_information":[{"code":"258","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28920.7,"maximum":48928.98,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37165.94},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28920.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28920.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36178.66},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":37304.95},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39158.08},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28920.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28920.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":42563.14},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28920.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28920.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28920.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28920.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28920.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28920.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28920.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48928.98},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44692.83},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28920.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21633.57,"10th_percentile":21633.57,"90th_percentile":21633.57,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Upper Limb And Toe Amputation For Circulatory System Disorders Without Cc/Mcc","code_information":[{"code":"257","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10396.92,"maximum":15555.63,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11815.89},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10396.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10396.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11502.01},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11860.08},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12449.24},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10396.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10396.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":13531.78},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10396.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10396.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10396.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10396.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10396.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10396.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10396.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15555.63},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14208.86},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10396.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":76211.17,"10th_percentile":76211.17,"90th_percentile":76211.17,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Upper Limb And Toe Amputation For Circulatory System Disorders With Cc","code_information":[{"code":"256","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15870.28,"maximum":29538.08,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22436.81},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15870.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15870.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21840.8},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":22520.73},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23639.46},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15870.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15870.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":25695.06},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15870.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15870.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15870.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15870.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15870.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15870.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15870.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29538.08},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26980.74},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15870.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10914.4,"10th_percentile":10914.4,"90th_percentile":10914.4,"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":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc","code_information":[{"code":"255","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24902.2,"maximum":45630.89,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34660.74},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24902.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24902.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33740.01},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":34790.38},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36518.6},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24902.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24902.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":39694.14},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24902.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24902.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24902.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24902.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24902.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24902.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24902.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45630.89},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41680.28},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24902.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":16627.54,"maximum":30509.54,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23174.73},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16627.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16627.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22559.11},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":23261.4},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24416.92},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16627.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16627.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":26540.13},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16627.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16627.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16627.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16627.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16627.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16627.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16627.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30509.54},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27868.1},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16627.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22532.64,"10th_percentile":22532.64,"90th_percentile":22532.64,"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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13633.91,"10th_percentile":13633.91,"90th_percentile":13633.91,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":46603.96,"10th_percentile":46603.96,"90th_percentile":46603.96,"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":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13844.15,"10th_percentile":13844.15,"90th_percentile":13844.15,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":77384.58,"10th_percentile":42906.79,"90th_percentile":92347.03,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":23754.74,"10th_percentile":23754.74,"90th_percentile":23754.74},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":13768.89,"10th_percentile":13768.89,"90th_percentile":13768.89,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12494.68,"10th_percentile":12494.68,"90th_percentile":12494.68,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":11347.85,"10th_percentile":11347.85,"90th_percentile":11347.85,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12472.61,"10th_percentile":12472.61,"90th_percentile":12472.61,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Vascular Procedures With Cc","code_information":[{"code":"253","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23982.29,"maximum":44525.13,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33820.82},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23982.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23982.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32922.4},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":33947.32},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35633.66},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23982.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23982.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":38732.24},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23982.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23982.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23982.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23982.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23982.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23982.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23982.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44525.13},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40670.25},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23982.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":33822.14,"10th_percentile":33822.14,"90th_percentile":33822.14,"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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13668.91,"10th_percentile":13644.91,"90th_percentile":20556.0,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":86535.97,"10th_percentile":86535.97,"90th_percentile":131237.64,"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":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":12505.77,"10th_percentile":8952.75,"90th_percentile":26519.9,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17984.52,"10th_percentile":17984.52,"90th_percentile":17984.52,"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":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":113601.42,"10th_percentile":63426.49,"90th_percentile":126872.19,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":39934.25,"10th_percentile":39934.25,"90th_percentile":39934.25},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23526.81,"10th_percentile":23526.81,"90th_percentile":23526.81,"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":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":15203.34,"10th_percentile":13578.34,"90th_percentile":49989.41,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19736.99,"10th_percentile":18591.92,"90th_percentile":20883.72,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17285.12,"10th_percentile":17285.12,"90th_percentile":17285.12,"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":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":15184.13,"10th_percentile":15184.13,"90th_percentile":15184.13,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19337.53,"10th_percentile":18733.2,"90th_percentile":20563.5,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Vascular Procedures With Mcc","code_information":[{"code":"252","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32049.11,"maximum":59826.12,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45443.29},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32049.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32049.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44236.13},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":45613.26},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":47879.11},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32049.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32049.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":52042.51},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32049.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32049.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32049.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32049.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32049.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32049.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32049.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59826.12},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":54646.52},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32049.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":43086.72,"10th_percentile":43086.72,"90th_percentile":43086.72,"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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":48163.53,"10th_percentile":48163.53,"90th_percentile":48163.53,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25039.62,"10th_percentile":24632.37,"90th_percentile":26388.56,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24748.14,"10th_percentile":24748.14,"90th_percentile":24748.14,"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":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":127208.96,"10th_percentile":127208.96,"90th_percentile":127208.96,"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":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":136054.07,"10th_percentile":136054.07,"90th_percentile":136054.07,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":13889.37,"10th_percentile":13889.37,"90th_percentile":13889.37,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10475.71,"10th_percentile":10475.71,"90th_percentile":10475.71,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25648.98,"10th_percentile":25648.98,"90th_percentile":25648.98,"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":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":82085.5,"10th_percentile":82085.5,"90th_percentile":82085.5,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":16209.13,"10th_percentile":16209.13,"90th_percentile":20450.54,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26044.74,"10th_percentile":25817.32,"90th_percentile":27450.17,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":41996.59,"10th_percentile":41996.59,"90th_percentile":41996.59,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":24177.44,"10th_percentile":24177.44,"90th_percentile":24177.44,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26425.76,"10th_percentile":25229.32,"90th_percentile":27448.03,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures Without Intraluminal Device Without Mcc","code_information":[{"code":"251","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14032.27,"maximum":27251.56,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20700.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14032.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14032.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20150.13},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":20777.42},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21809.55},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14032.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14032.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":23706.03},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14032.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14032.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14032.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14032.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14032.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14032.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14032.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27251.56},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24892.19},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14032.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11656.39,"10th_percentile":11656.39,"90th_percentile":11656.39,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc","code_information":[{"code":"250","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20249.34,"maximum":40335.8,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30638.65},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20249.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20249.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29824.76},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":30753.24},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32280.92},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20249.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20249.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":35087.96},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20249.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20249.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20249.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20249.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20249.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20249.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20249.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40335.8},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36843.62},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20249.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":61661.78,"10th_percentile":61661.78,"90th_percentile":61661.78,"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":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":205969.05,"10th_percentile":205969.05,"90th_percentile":205969.05,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17899.97,"10th_percentile":17899.97,"90th_percentile":17899.97,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17949.05,"10th_percentile":17949.05,"90th_percentile":17949.05,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aicd Generator Procedures","code_information":[{"code":"245","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":41755.14,"maximum":85225.45,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64736.35},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41755.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41755.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":63016.69},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":64978.48},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":68206.3},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41755.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41755.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":74137.29},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41755.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41755.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41755.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41755.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41755.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41755.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41755.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":85225.45},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":77846.83},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41755.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":35438.81,"10th_percentile":35438.81,"90th_percentile":35438.81,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Permanent Cardiac Pacemaker Implant Without Cc/Mcc","code_information":[{"code":"244","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16860.68,"maximum":31475.77,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23908.67},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16860.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16860.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23273.56},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":23998.09},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25190.2},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16860.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16860.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":27380.66},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16860.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16860.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16860.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16860.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16860.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16860.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16860.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31475.77},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28750.68},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16860.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14055.53,"10th_percentile":13861.5,"90th_percentile":14423.5,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":76975.49,"10th_percentile":76975.49,"90th_percentile":76975.49,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14052.79,"10th_percentile":14052.79,"90th_percentile":14052.79,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":13516.18,"10th_percentile":13516.18,"90th_percentile":13516.18,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14487.84,"10th_percentile":14487.84,"90th_percentile":14487.84,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Permanent Cardiac Pacemaker Implant With Cc","code_information":[{"code":"243","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19783.06,"maximum":39289.34,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29843.77},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19783.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19783.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29051.0},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":29955.39},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31443.43},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19783.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19783.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":34177.65},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19783.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19783.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19783.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19783.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19783.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19783.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19783.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39289.34},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35887.76},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19783.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14100.38,"10th_percentile":13770.15,"90th_percentile":17471.18,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15804.49,"10th_percentile":15804.49,"90th_percentile":15804.49,"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":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":189381.76,"10th_percentile":189381.76,"90th_percentile":189381.76,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12158.35,"10th_percentile":12158.35,"90th_percentile":12158.35,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":116872.1,"10th_percentile":116872.1,"90th_percentile":116872.1,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14507.08,"10th_percentile":14507.08,"90th_percentile":14507.08,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17255.91,"10th_percentile":16721.24,"90th_percentile":17482.02,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":18849.55,"10th_percentile":18849.55,"90th_percentile":18849.55,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"1 through 10","median_amount":35889.36,"10th_percentile":35889.36,"90th_percentile":35889.36,"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":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16983.31,"10th_percentile":16957.01,"90th_percentile":16998.31,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Permanent Cardiac Pacemaker Implant With Mcc","code_information":[{"code":"242","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29378.84,"maximum":59159.87,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44937.22},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29378.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29378.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43743.5},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":45105.29},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":47345.91},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29378.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29378.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":51462.95},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29378.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29378.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29378.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29378.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29378.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29378.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29378.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59159.87},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":54037.95},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29378.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26099.48,"10th_percentile":26099.48,"90th_percentile":26099.48,"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":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":94781.16,"10th_percentile":94781.16,"90th_percentile":94781.16,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25166.64,"10th_percentile":24297.73,"90th_percentile":52984.83,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":16106.6,"10th_percentile":16106.6,"90th_percentile":16106.6,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27535.35,"10th_percentile":27535.35,"90th_percentile":27535.35,"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":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":58277.32,"10th_percentile":58277.32,"90th_percentile":58277.32,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25341.13,"10th_percentile":25013.13,"90th_percentile":26108.68,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/Mcc","code_information":[{"code":"241","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13037.36,"maximum":26332.42,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20001.83},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13037.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13037.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19470.5},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":20076.64},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21073.95},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13037.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13037.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":22906.47},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13037.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13037.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13037.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13037.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13037.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13037.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13037.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26332.42},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24052.62},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13037.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc","code_information":[{"code":"240","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26285.67,"maximum":50788.19,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38578.18},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26285.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26285.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37553.38},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":38722.47},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40646.02},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26285.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26285.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":44180.46},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26285.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26285.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26285.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26285.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26285.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26285.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26285.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50788.19},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":46391.07},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26285.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":52211.39,"10th_percentile":52211.39,"90th_percentile":52211.39,"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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":96830.22,"10th_percentile":96830.22,"90th_percentile":96830.22,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18513.06,"10th_percentile":18513.06,"90th_percentile":18513.06,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":13090.35,"10th_percentile":13090.35,"90th_percentile":13090.35,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26784.08,"10th_percentile":26784.08,"90th_percentile":26784.08,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24002.8,"10th_percentile":24002.8,"90th_percentile":24002.8,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Interstitial Lung Disease Without Cc/Mcc","code_information":[{"code":"198","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6999.22,"maximum":12215.68,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9278.9},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6999.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6999.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9032.41},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":9313.6},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9776.26},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6999.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6999.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10626.37},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6999.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6999.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6999.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6999.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6999.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6999.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6999.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12215.68},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11158.07},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6999.22,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":8051.22,"10th_percentile":8051.22,"90th_percentile":8051.22,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5295.28,"10th_percentile":5295.28,"90th_percentile":5295.28,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Interstitial Lung Disease With Cc","code_information":[{"code":"197","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9103.81,"maximum":17264.85,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13114.2},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9103.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9103.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12765.83},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":13163.24},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13817.13},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9103.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9103.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":15018.62},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9103.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9103.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9103.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9103.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9103.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9103.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9103.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17264.85},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15770.1},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9103.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7901.47,"10th_percentile":7901.47,"90th_percentile":7901.47,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":6750.94,"10th_percentile":6750.94,"90th_percentile":6750.94},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7316.47,"10th_percentile":7316.47,"90th_percentile":7316.47,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Interstitial Lung Disease With Mcc","code_information":[{"code":"196","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17580.88,"maximum":32862.33,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24961.88},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17580.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17580.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24298.79},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":25055.24},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26299.87},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17580.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17580.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":28586.82},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17580.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17580.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17580.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17580.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17580.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17580.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17580.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32862.33},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30017.19},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17580.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":119069.78,"10th_percentile":119069.78,"90th_percentile":119069.78,"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":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14254.7,"10th_percentile":14254.7,"90th_percentile":14254.7,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14654.22,"10th_percentile":13582.82,"90th_percentile":15087.99,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":10176.4,"10th_percentile":10176.4,"90th_percentile":10176.4,"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":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":15450.58,"10th_percentile":15450.58,"90th_percentile":15450.58,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14667.2,"10th_percentile":14667.2,"90th_percentile":14667.2,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simple Pneumonia And Pleurisy Without Cc/Mcc","code_information":[{"code":"195","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6206.73,"maximum":10862.25,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8250.85},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6206.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6206.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8031.68},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":8281.71},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8693.11},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6206.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6206.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":9449.03},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6206.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6206.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6206.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6206.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6206.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6206.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6206.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10862.25},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9921.83},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6206.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5111.0,"10th_percentile":5111.0,"90th_percentile":5111.0,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":6898.71,"10th_percentile":6898.71,"90th_percentile":6898.71,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18609.84,"10th_percentile":18609.84,"90th_percentile":18609.84,"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":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":4585.48,"10th_percentile":4585.48,"90th_percentile":4585.48,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":17916.69,"10th_percentile":9563.21,"90th_percentile":45073.08,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":8348.12,"10th_percentile":8348.12,"90th_percentile":8348.12},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5369.48,"10th_percentile":5369.48,"90th_percentile":5369.48,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":3412.9,"10th_percentile":3412.9,"90th_percentile":3412.9,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":390.84,"10th_percentile":390.84,"90th_percentile":390.84,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":10961.67,"10th_percentile":10961.67,"90th_percentile":10961.67,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"1 through 10","median_amount":6683.26,"10th_percentile":6683.26,"90th_percentile":6683.26,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5127.47,"10th_percentile":4698.08,"90th_percentile":5369.1,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":7809.79,"maximum":14301.62,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10863.36},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7809.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7809.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10574.79},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":10903.99},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11445.65},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7809.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7809.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":12440.93},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7809.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7809.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7809.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7809.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7809.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7809.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7809.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14301.62},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13063.42},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7809.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10863.36,"10th_percentile":8690.69,"90th_percentile":10863.36,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":4181.62,"10th_percentile":383.18,"90th_percentile":5674.41,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"14","median_amount":6599.12,"10th_percentile":4771.17,"90th_percentile":6614.03,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5012.56,"10th_percentile":5012.56,"90th_percentile":5012.56,"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":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":21253.43,"10th_percentile":14875.27,"90th_percentile":25171.99,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25432.58,"10th_percentile":16555.04,"90th_percentile":70724.15,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":4185.98,"10th_percentile":383.18,"90th_percentile":6208.02,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"11","median_amount":6611.61,"10th_percentile":5764.42,"90th_percentile":7483.39,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6536.54,"10th_percentile":6536.54,"90th_percentile":6536.54,"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":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"19","median_amount":25200.22,"10th_percentile":8946.81,"90th_percentile":42319.43,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":9466.49,"10th_percentile":9466.49,"90th_percentile":9466.49},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":3813.74,"10th_percentile":3412.9,"90th_percentile":4181.62,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6064.84,"10th_percentile":6064.84,"90th_percentile":6064.84,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"25","median_amount":6155.01,"10th_percentile":947.74,"90th_percentile":6659.36,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6683.12,"10th_percentile":6683.12,"90th_percentile":6683.12,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5096.23,"10th_percentile":5096.23,"90th_percentile":5096.23,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient 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":4181.62,"10th_percentile":3412.9,"90th_percentile":6208.02,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5824.84,"10th_percentile":5824.84,"90th_percentile":5824.84,"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 Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":4677.19,"10th_percentile":4677.19,"90th_percentile":4677.19,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":14301.62,"10th_percentile":14301.62,"90th_percentile":14301.62,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"1 through 10","median_amount":13063.42,"10th_percentile":13063.42,"90th_percentile":13063.42,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"27","median_amount":6593.97,"10th_percentile":4776.82,"90th_percentile":6615.42,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simple Pneumonia And Pleurisy With Mcc","code_information":[{"code":"193","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12404.81,"maximum":22983.75,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17458.21},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12404.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12404.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16994.45},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":17523.51},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18394.0},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12404.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12404.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":19993.48},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12404.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12404.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12404.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12404.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12404.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12404.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12404.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22983.75},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20993.87},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12404.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17413.17,"10th_percentile":16393.08,"90th_percentile":17456.89,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":6208.02,"10th_percentile":5626.82,"90th_percentile":7378.07,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"28","median_amount":10301.2,"10th_percentile":5099.47,"90th_percentile":10664.54,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10170.92,"10th_percentile":10170.92,"90th_percentile":10170.92,"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":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":36753.8,"10th_percentile":27376.12,"90th_percentile":45523.86,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":32464.34,"10th_percentile":23032.68,"90th_percentile":131089.3,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":6208.02,"10th_percentile":5654.13,"90th_percentile":9144.49,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10404.3,"10th_percentile":10363.89,"90th_percentile":11978.82,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10061.78,"10th_percentile":10061.78,"90th_percentile":10345.39,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"28","median_amount":36330.31,"10th_percentile":19207.72,"90th_percentile":76957.89,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":11771.92,"10th_percentile":11771.92,"90th_percentile":15235.39},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10426.3,"10th_percentile":10426.3,"90th_percentile":10426.3,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":5654.13,"10th_percentile":4440.07,"90th_percentile":9144.49,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"22","median_amount":8893.9,"10th_percentile":6599.61,"90th_percentile":10396.67,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8837.93,"10th_percentile":8837.93,"90th_percentile":8837.93,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7578.19,"10th_percentile":7578.19,"90th_percentile":7578.19,"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":"[Inpatient 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":6208.02,"10th_percentile":4785.35,"90th_percentile":9144.49,"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":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8169.88,"10th_percentile":8126.76,"90th_percentile":8761.31,"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":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":18385.59,"10th_percentile":10458.52,"90th_percentile":22982.01,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"24","median_amount":8437.47,"10th_percentile":5177.3,"90th_percentile":10372.97,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chronic Obstructive Pulmonary Disease Without Cc/Mcc","code_information":[{"code":"192","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6328.72,"maximum":11287.82,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8574.11},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6328.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6328.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8346.34},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":8606.17},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9033.69},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6328.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6328.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":9819.23},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6328.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6328.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6328.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6328.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6328.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6328.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6328.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11287.82},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10310.54},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6328.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":4406.75,"10th_percentile":4406.75,"90th_percentile":4406.75,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5299.25,"10th_percentile":5299.25,"90th_percentile":5299.25,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21423.14,"10th_percentile":21423.14,"90th_percentile":21423.14,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":306.38,"10th_percentile":306.38,"90th_percentile":306.38,"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":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":11037.82,"10th_percentile":11037.82,"90th_percentile":11037.82,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5307.19,"10th_percentile":5307.19,"90th_percentile":5307.19,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chronic Obstructive Pulmonary Disease With Cc","code_information":[{"code":"191","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8145.04,"maximum":14983.56,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11381.36},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8145.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8145.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11079.02},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11423.93},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11991.41},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8145.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8145.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":13034.14},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8145.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8145.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8145.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8145.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8145.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8145.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8145.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14983.56},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13686.32},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8145.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17022.13,"10th_percentile":17022.13,"90th_percentile":17022.13,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":4590.92,"10th_percentile":4590.92,"90th_percentile":6562.98,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6249.25,"10th_percentile":6249.25,"90th_percentile":6249.25,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":4741.59,"10th_percentile":4741.59,"90th_percentile":4741.59,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7030.76,"10th_percentile":7030.76,"90th_percentile":7030.76,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6683.44,"10th_percentile":6683.44,"90th_percentile":6683.44,"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":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5911.14,"10th_percentile":5911.14,"90th_percentile":5911.14,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":7069.15,"10th_percentile":7069.15,"90th_percentile":7069.15,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7025.12,"10th_percentile":7025.12,"90th_percentile":7025.12,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":5620.4,"10th_percentile":5620.4,"90th_percentile":6562.98,"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":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5279.04,"10th_percentile":5279.04,"90th_percentile":5279.04,"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 Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2577.88,"10th_percentile":282.87,"90th_percentile":6896.05,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chronic Obstructive Pulmonary Disease With Mcc","code_information":[{"code":"190","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10536.98,"maximum":19591.48,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14881.48},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10536.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10536.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14486.17},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":14937.14},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15679.14},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10536.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10536.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":17042.55},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10536.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10536.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10536.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10536.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10536.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10536.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10536.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19591.48},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17895.29},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10536.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":7511.1,"10th_percentile":7511.1,"90th_percentile":7511.1,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8896.16,"10th_percentile":5289.12,"90th_percentile":9068.74,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":51834.09,"10th_percentile":51834.09,"90th_percentile":51834.09,"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":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":5174.81,"10th_percentile":5174.81,"90th_percentile":5174.81,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9070.51,"10th_percentile":9070.51,"90th_percentile":9070.51,"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":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8646.33,"10th_percentile":8646.33,"90th_percentile":8646.33,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":41453.51,"10th_percentile":41453.51,"90th_percentile":41453.51,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"18","median_amount":8793.99,"10th_percentile":6210.04,"90th_percentile":8913.75,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":5684.17,"10th_percentile":5178.32,"90th_percentile":8258.49,"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":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"13","median_amount":7737.24,"10th_percentile":6898.14,"90th_percentile":9068.74,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pulmonary Edema And Respiratory Failure","code_information":[{"code":"189","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11690.94,"maximum":21583.24,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16394.4},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11690.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11690.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15958.9},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":16455.72},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17273.16},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11690.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11690.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":18775.18},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11690.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11690.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11690.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11690.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11690.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11690.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11690.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21583.24},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19714.61},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11690.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16393.08,"10th_percentile":16393.08,"90th_percentile":16393.08,"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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":5628.95,"10th_percentile":5385.15,"90th_percentile":9404.75,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"12","median_amount":9775.42,"10th_percentile":9755.46,"90th_percentile":10070.39,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":41108.07,"10th_percentile":11060.58,"90th_percentile":50639.6,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":5387.15,"10th_percentile":4048.55,"90th_percentile":9771.46,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9802.57,"10th_percentile":9768.45,"90th_percentile":10055.39,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9471.25,"10th_percentile":9471.25,"90th_percentile":9471.25,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"12","median_amount":41473.94,"10th_percentile":23742.07,"90th_percentile":88746.28,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":18976.09,"10th_percentile":18976.09,"90th_percentile":18976.09},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9763.42,"10th_percentile":9763.42,"90th_percentile":9763.42,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":7152.73,"10th_percentile":4820.38,"90th_percentile":9100.46,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"18","median_amount":9573.07,"10th_percentile":906.45,"90th_percentile":9771.25,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9903.11,"10th_percentile":9903.11,"90th_percentile":9903.11,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10054.63,"10th_percentile":10054.63,"90th_percentile":10054.63,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":5385.15,"10th_percentile":5385.15,"90th_percentile":7152.73,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7531.44,"10th_percentile":7531.44,"90th_percentile":7531.44,"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 Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":7295.79,"10th_percentile":7295.79,"90th_percentile":7295.79,"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":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"16","median_amount":7940.62,"10th_percentile":5073.24,"90th_percentile":9764.18,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pleural Effusion Without Cc/Mcc","code_information":[{"code":"188","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7008.26,"maximum":12803.44,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9725.36},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7008.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7008.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9467.01},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":9761.73},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10246.65},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7008.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7008.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11137.66},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7008.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7008.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7008.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7008.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7008.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7008.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7008.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12803.44},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11694.95},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7008.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5660.02,"10th_percentile":5660.02,"90th_percentile":5660.02,"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":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pleural Effusion With Cc","code_information":[{"code":"187","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9465.26,"maximum":17509.02,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13299.67},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9465.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9465.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12946.37},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":13349.41},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14012.55},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9465.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9465.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":15231.03},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9465.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9465.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9465.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9465.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9465.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9465.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9465.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17509.02},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15993.13},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9465.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7994.62,"10th_percentile":7994.62,"90th_percentile":7994.62,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":27291.97,"10th_percentile":27291.97,"90th_percentile":27291.97,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":65903.15,"10th_percentile":65903.15,"90th_percentile":65903.15,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8173.21,"10th_percentile":8173.21,"90th_percentile":8173.21,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7932.22,"10th_percentile":7932.22,"90th_percentile":7932.22,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8111.85,"10th_percentile":8111.85,"90th_percentile":8111.85,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":5908.98,"10th_percentile":5908.98,"90th_percentile":5908.98,"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":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pleural Effusion With Mcc","code_information":[{"code":"186","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14610.61,"maximum":27556.78,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20931.84},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14610.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14610.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20375.81},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":21010.13},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22053.81},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14610.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14610.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":23971.54},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14610.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14610.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14610.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14610.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14610.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14610.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14610.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27556.78},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25170.98},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14610.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":382.66,"10th_percentile":382.66,"90th_percentile":382.66,"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":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":134903.92,"10th_percentile":134903.92,"90th_percentile":134903.92,"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":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":6836.0,"10th_percentile":6836.0,"90th_percentile":6836.0,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":8927.95,"10th_percentile":8927.95,"90th_percentile":8927.95,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12368.92,"10th_percentile":12368.92,"90th_percentile":12368.92,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":7088.87,"10th_percentile":7088.87,"90th_percentile":7088.87,"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":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":27181.8,"10th_percentile":27181.8,"90th_percentile":27181.8,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11976.38,"10th_percentile":11976.38,"90th_percentile":11976.38,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Trauma Without Cc/Mcc","code_information":[{"code":"185","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7634.48,"maximum":13562.12,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10301.64},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7634.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7634.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10027.99},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":10340.17},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10853.83},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7634.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7634.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11797.64},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7634.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7634.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7634.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7634.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7634.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7634.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7634.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13562.12},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12387.95},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7634.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6294.51,"10th_percentile":6294.51,"90th_percentile":6294.51,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":13543.05,"10th_percentile":13543.05,"90th_percentile":13543.05,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Trauma With Cc","code_information":[{"code":"184","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10143.0,"maximum":18626.99,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14148.86},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10143.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10143.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13773.01},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":14201.78},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14907.26},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10143.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10143.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":16203.55},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10143.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10143.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10143.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10143.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10143.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10143.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10143.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18626.99},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17014.31},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10143.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8480.61,"10th_percentile":8480.61,"90th_percentile":8480.61,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":29871.81,"10th_percentile":29871.81,"90th_percentile":29871.81,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8203.68,"10th_percentile":8203.68,"90th_percentile":8203.68,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":45364.98,"10th_percentile":45364.98,"90th_percentile":45364.98,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7899.95,"10th_percentile":7899.95,"90th_percentile":7899.95,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":13970.89,"10th_percentile":13970.89,"90th_percentile":13970.89,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4949.0,"10th_percentile":4949.0,"90th_percentile":4949.0,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":14352.16,"maximum":27682.36,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21027.23},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14352.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14352.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20468.66},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":21105.87},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22154.31},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14352.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14352.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":24080.78},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14352.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14352.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14352.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14352.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14352.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14352.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14352.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27682.36},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25285.68},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14352.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26685.42,"10th_percentile":26685.42,"90th_percentile":26685.42,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12818.04,"10th_percentile":12818.04,"90th_percentile":12818.04,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"1 through 10","median_amount":22590.13,"10th_percentile":22590.13,"90th_percentile":22590.13,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12406.04,"10th_percentile":12406.04,"90th_percentile":12406.04,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Neoplasms Without Cc/Mcc","code_information":[{"code":"182","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7338.99,"maximum":14606.84,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11095.2},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7338.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7338.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10800.47},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11136.7},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11689.92},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7338.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7338.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":12706.43},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7338.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7338.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7338.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7338.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7338.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7338.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7338.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14606.84},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13342.21},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7338.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10991.5,"10th_percentile":10991.5,"90th_percentile":10991.5,"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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":10205.35,"maximum":19363.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14707.93},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10205.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10205.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14317.23},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":14762.94},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15496.29},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10205.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10205.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":16843.8},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10205.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10205.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10205.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10205.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10205.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10205.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10205.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19363.0},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17686.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10205.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":9951.81,"10th_percentile":9951.81,"90th_percentile":9951.81,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8785.4,"10th_percentile":8785.4,"90th_percentile":8785.4,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8796.46,"10th_percentile":8796.46,"90th_percentile":8796.46,"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":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":37845.35,"10th_percentile":37845.35,"90th_percentile":37845.35,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8708.83,"10th_percentile":8708.83,"90th_percentile":8708.83,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":29505.65,"10th_percentile":29119.62,"90th_percentile":36403.52,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8808.44,"10th_percentile":8808.44,"90th_percentile":8808.44,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6589.13,"10th_percentile":6589.13,"90th_percentile":6589.13,"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 Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":18486.5,"10th_percentile":18486.5,"90th_percentile":18486.5,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8792.91,"10th_percentile":8580.86,"90th_percentile":8800.54,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":16485.67,"maximum":30481.64,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23153.53},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16485.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16485.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22538.48},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":23240.13},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24394.59},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16485.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16485.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":26515.86},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16485.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16485.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16485.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16485.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16485.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16485.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16485.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30481.64},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27842.61},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16485.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13621.75,"10th_percentile":13621.75,"90th_percentile":13679.38,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":32715.01,"10th_percentile":32715.01,"90th_percentile":32715.01,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":49098.07,"10th_percentile":45856.23,"90th_percentile":110242.65,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13633.82,"10th_percentile":13633.82,"90th_percentile":13642.62,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":30483.38,"10th_percentile":30483.38,"90th_percentile":30483.38,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13632.77,"10th_percentile":13632.77,"90th_percentile":13632.77,"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":"Youthcare","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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10464.23,"10th_percentile":10464.23,"90th_percentile":10464.23,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":921.05,"10th_percentile":921.05,"90th_percentile":921.05,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":10002.96,"10th_percentile":10002.96,"90th_percentile":10002.96,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":7493.23,"10th_percentile":7493.23,"90th_percentile":7493.23},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4525.96,"10th_percentile":4525.96,"90th_percentile":4525.96,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":5666.06,"10th_percentile":5666.06,"90th_percentile":5666.06,"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":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6227.95,"10th_percentile":6227.95,"90th_percentile":6227.95,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":9346.89,"maximum":17303.22,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13143.34},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9346.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9346.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12794.2},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":13192.5},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13847.84},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9346.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9346.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":15052.0},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9346.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9346.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9346.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9346.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9346.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9346.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9346.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17303.22},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15805.15},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9346.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":36123.78,"10th_percentile":36123.78,"90th_percentile":36123.78,"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":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21817.18,"10th_percentile":21817.18,"90th_percentile":61521.42,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":5162.28,"10th_percentile":5162.28,"90th_percentile":5162.28,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7948.6,"10th_percentile":7448.29,"90th_percentile":9022.42,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7810.38,"10th_percentile":7810.38,"90th_percentile":7810.38,"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":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":21102.2,"10th_percentile":16608.87,"90th_percentile":89574.82,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":8598.15,"10th_percentile":8598.15,"90th_percentile":8598.15},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7067.04,"10th_percentile":7067.04,"90th_percentile":7067.04,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":6900.34,"10th_percentile":6900.34,"90th_percentile":8933.1,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7427.89,"10th_percentile":6868.57,"90th_percentile":7907.7,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7990.43,"10th_percentile":7990.43,"90th_percentile":7990.43,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":5666.06,"10th_percentile":5666.06,"90th_percentile":7201.08,"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":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5712.81,"10th_percentile":5712.81,"90th_percentile":5712.81,"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 Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":16066.42,"10th_percentile":16066.42,"90th_percentile":16066.42,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7162.57,"10th_percentile":5081.61,"90th_percentile":7903.8,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":14648.56,"maximum":28193.38,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21415.39},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14648.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14648.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20846.51},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":21495.49},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22563.28},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14648.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14648.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":24525.31},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14648.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14648.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14648.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14648.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14648.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14648.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14648.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28193.38},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25752.46},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14648.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18323.49,"10th_percentile":18323.49,"90th_percentile":18323.49,"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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":7941.42,"10th_percentile":6903.11,"90th_percentile":11295.34,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"26","median_amount":11243.83,"10th_percentile":6221.32,"90th_percentile":12640.39,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12627.19,"10th_percentile":12627.19,"90th_percentile":12627.19,"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":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":93867.82,"10th_percentile":93867.82,"90th_percentile":93867.82,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24127.14,"10th_percentile":18537.83,"90th_percentile":60169.92,"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":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":7584.26,"10th_percentile":7584.26,"90th_percentile":7584.26,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12662.69,"10th_percentile":12638.36,"90th_percentile":14438.94,"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":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"13","median_amount":59627.98,"10th_percentile":28164.36,"90th_percentile":130680.01,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12666.69,"10th_percentile":12621.9,"90th_percentile":12891.14,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":9808.29,"10th_percentile":5666.06,"90th_percentile":50948.43,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"34","median_amount":11863.87,"10th_percentile":6531.38,"90th_percentile":12646.73,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12801.97,"10th_percentile":12801.97,"90th_percentile":12801.97,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10939.05,"10th_percentile":10939.05,"90th_percentile":10994.91,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":10785.43,"10th_percentile":7584.26,"90th_percentile":29661.79,"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":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10342.04,"10th_percentile":10153.76,"90th_percentile":10342.04,"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 Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":11363.57,"10th_percentile":11363.57,"90th_percentile":11363.57,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":12420.14,"10th_percentile":12420.14,"90th_percentile":12420.14,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"1 through 10","median_amount":24895.37,"10th_percentile":24895.37,"90th_percentile":24895.37,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"23","median_amount":11903.37,"10th_percentile":10304.37,"90th_percentile":12637.4,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pulmonary Embolism Without Mcc","code_information":[{"code":"176","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7801.66,"maximum":14205.69,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10790.5},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7801.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7801.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10503.86},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":10830.85},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11368.88},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7801.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7801.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":12357.48},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7801.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7801.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7801.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7801.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7801.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7801.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7801.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14205.69},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12975.8},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7801.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10033.84,"10th_percentile":10033.84,"90th_percentile":10790.5,"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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":4275.83,"10th_percentile":4275.83,"90th_percentile":4275.83,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6557.42,"10th_percentile":6555.49,"90th_percentile":6569.6,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":36158.41,"10th_percentile":36158.41,"90th_percentile":36158.41,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9367.26,"10th_percentile":9367.26,"90th_percentile":9367.26,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":7468.34,"10th_percentile":7468.34,"90th_percentile":7468.34,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":35800.96,"10th_percentile":24500.91,"90th_percentile":54963.06,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":17065.63,"10th_percentile":17065.63,"90th_percentile":18273.04},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2295.27,"10th_percentile":2295.27,"90th_percentile":2295.27,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6448.66,"10th_percentile":6214.42,"90th_percentile":6593.57,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":6789.88,"10th_percentile":4783.46,"90th_percentile":7468.34,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":14205.69,"10th_percentile":14205.69,"90th_percentile":14205.69,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"1 through 10","median_amount":12975.8,"10th_percentile":12975.8,"90th_percentile":12975.8,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4729.51,"10th_percentile":4729.51,"90th_percentile":4732.12,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":12939.77,"maximum":24576.11,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18667.76},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12939.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12939.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18171.87},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":18737.58},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19668.37},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12939.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12939.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":21378.67},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12939.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12939.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12939.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12939.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12939.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12939.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12939.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24576.11},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22448.37},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12939.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18053.8,"10th_percentile":18053.8,"90th_percentile":18053.8,"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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11079.92,"10th_percentile":11056.22,"90th_percentile":11121.6,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":36986.84,"10th_percentile":36986.84,"90th_percentile":36986.84,"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":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23510.96,"10th_percentile":23510.96,"90th_percentile":23510.96,"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":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":7230.15,"10th_percentile":7230.15,"90th_percentile":7230.15,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11065.92,"10th_percentile":11065.92,"90th_percentile":11091.22,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":73437.32,"10th_percentile":44007.49,"90th_percentile":79065.28,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":230.05,"10th_percentile":230.05,"90th_percentile":230.05,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7542.55,"10th_percentile":5234.91,"90th_percentile":11087.14,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11180.31,"10th_percentile":11180.31,"90th_percentile":11180.31,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":6789.88,"10th_percentile":6789.88,"90th_percentile":6789.88,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":24576.11,"10th_percentile":24576.11,"90th_percentile":24576.11,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9233.43,"10th_percentile":9120.73,"90th_percentile":11065.93,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary Embolism","code_information":[{"code":"173","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27423.36,"maximum":53515.96,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40650.16},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27423.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27423.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39570.33},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":40802.2},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":42829.06},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27423.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27423.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":46553.34},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27423.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27423.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27423.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27423.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27423.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27423.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27423.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53515.96},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":48882.68},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27423.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System O.R. Procedures Without Cc/Mcc","code_information":[{"code":"168","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12874.71,"maximum":23611.63,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17935.14},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12874.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12874.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17458.71},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":18002.22},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18896.49},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12874.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12874.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":20539.66},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12874.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12874.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12874.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12874.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12874.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12874.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12874.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23611.63},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21567.39},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12874.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17382.24,"10th_percentile":17382.24,"90th_percentile":17382.24,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":44846.47,"10th_percentile":44846.47,"90th_percentile":44846.47,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":60456.26,"10th_percentile":60456.26,"90th_percentile":60456.26,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":45896.19,"10th_percentile":45896.19,"90th_percentile":45896.19,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":16447.77,"10th_percentile":16447.77,"90th_percentile":16447.77},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10438.71,"10th_percentile":10438.71,"90th_percentile":10645.92,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":9364.96,"10th_percentile":9364.96,"90th_percentile":9364.96,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":23831.38,"10th_percentile":23831.38,"90th_percentile":23831.38,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System 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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13851.84,"10th_percentile":13851.84,"90th_percentile":13851.84,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":5276.42,"10th_percentile":5276.42,"90th_percentile":5276.42,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14085.37,"10th_percentile":14085.37,"90th_percentile":14085.37,"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":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":100826.27,"10th_percentile":100826.27,"90th_percentile":100826.27,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14010.21,"10th_percentile":14010.21,"90th_percentile":14010.21,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sinus And Mastoid Procedures Without Cc/Mcc","code_information":[{"code":"136","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9702.02,"maximum":17060.79,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12959.19},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9702.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9702.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12614.95},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":13007.66},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13653.82},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9702.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9702.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":14841.11},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9702.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9702.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9702.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9702.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9702.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9702.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9702.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17060.79},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15583.7},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9702.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sinus And Mastoid Procedures With Cc/Mcc","code_information":[{"code":"135","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20136.38,"maximum":42048.51,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31939.6},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20136.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20136.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31091.16},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":32059.06},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33651.61},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20136.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20136.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":36577.84},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20136.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20136.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20136.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20136.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20136.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20136.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20136.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42048.51},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38408.05},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20136.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of The Eye Without Mcc","code_information":[{"code":"125","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7465.5,"maximum":14401.03,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10938.87},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7465.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7465.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10648.29},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":10979.79},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11525.21},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7465.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7465.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":12527.4},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7465.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7465.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7465.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7465.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7465.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7465.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7465.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14401.03},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13154.23},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7465.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8974.32,"10th_percentile":8974.32,"90th_percentile":8974.32,"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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6644.12,"10th_percentile":6644.12,"90th_percentile":6644.12,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":42572.85,"10th_percentile":42572.85,"90th_percentile":42572.85,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27814.83,"10th_percentile":27814.83,"90th_percentile":27814.83,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":3459.95,"10th_percentile":3459.95,"90th_percentile":3459.95,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":26818.25,"10th_percentile":14165.52,"90th_percentile":32344.31,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6152.33,"10th_percentile":6152.33,"90th_percentile":6152.33,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6676.66,"10th_percentile":6676.66,"90th_percentile":6676.66,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of The Eye With Mcc Or Thrombolytic Agent","code_information":[{"code":"124","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12483.43,"maximum":22739.58,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17272.74},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12483.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12483.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16813.91},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":17337.35},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18198.58},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12483.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12483.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":19781.07},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12483.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12483.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12483.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12483.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12483.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12483.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12483.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22739.58},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20770.84},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12483.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10293.15,"10th_percentile":10293.15,"90th_percentile":10293.15,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":4213.67,"10th_percentile":4213.67,"90th_percentile":4213.67,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neurological Eye Disorders","code_information":[{"code":"123","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7743.82,"maximum":14008.61,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10640.79},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7743.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7743.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10358.13},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":10680.59},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11211.15},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7743.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7743.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":12186.04},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7743.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7743.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7743.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7743.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7743.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7743.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7743.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14008.61},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12795.78},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7743.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9113.03,"10th_percentile":9113.03,"90th_percentile":9113.03,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":19601.87,"10th_percentile":19601.87,"90th_percentile":19601.87,"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":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":97239.04,"10th_percentile":97239.04,"90th_percentile":97239.04,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":3797.02,"10th_percentile":3797.02,"90th_percentile":3797.02,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":101.45,"10th_percentile":101.45,"90th_percentile":101.45,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":14008.61,"10th_percentile":14008.61,"90th_percentile":14008.61,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"1 through 10","median_amount":22157.33,"10th_percentile":22157.33,"90th_percentile":22157.33,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Major Eye Infections Without Cc/Mcc","code_information":[{"code":"122","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7628.16,"maximum":11830.23,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8986.12},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7628.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7628.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8747.41},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":9019.73},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9467.79},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7628.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7628.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10291.07},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7628.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7628.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7628.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7628.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7628.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7628.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7628.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11830.23},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10806.0},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7628.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":11039.41,"maximum":20285.63,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15408.75},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11039.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11039.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14999.43},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":15466.38},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16234.68},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11039.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11039.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":17646.39},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11039.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11039.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11039.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11039.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11039.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11039.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11039.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20285.63},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18529.35},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11039.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intraocular Procedures Without Cc/Mcc","code_information":[{"code":"117","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10330.95,"maximum":18811.86,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14289.29},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10330.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10330.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13909.71},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":14342.74},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15055.22},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10330.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10330.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":16364.37},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10330.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10330.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10330.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10330.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10330.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10330.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10330.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18811.86},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17183.18},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10330.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intraocular Procedures With Cc/Mcc","code_information":[{"code":"116","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16866.1,"maximum":29100.31,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22104.29},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16866.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16866.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21517.11},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":22186.96},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23289.11},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16866.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16866.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":25314.25},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16866.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16866.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16866.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16866.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16866.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16866.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16866.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29100.31},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26580.87},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16866.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":142095.73,"10th_percentile":142095.73,"90th_percentile":142095.73,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extraocular Procedures Except Orbit","code_information":[{"code":"115","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14397.35,"maximum":26700.43,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20281.36},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14397.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14397.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19742.61},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":20357.22},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21368.47},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14397.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14397.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":23226.6},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14397.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14397.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14397.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14397.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14397.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14397.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14397.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26700.43},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24388.77},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14397.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11404.24,"10th_percentile":11404.24,"90th_percentile":11404.24,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Orbital Procedures Without Cc/Mcc","code_information":[{"code":"114","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12753.62,"maximum":20617.01,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15660.46},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12753.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12753.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15244.46},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":15719.03},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16499.88},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12753.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12753.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":17934.66},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12753.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12753.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12753.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12753.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12753.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12753.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12753.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20617.01},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18832.04},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12753.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Orbital Procedures With Cc/Mcc","code_information":[{"code":"113","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21772.88,"maximum":39357.36,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29895.44},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21772.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21772.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29101.29},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":30007.25},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31497.87},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21772.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21772.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":34236.82},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21772.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21772.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21772.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21772.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21772.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21772.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21772.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39357.36},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35949.89},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21772.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":41002.4,"10th_percentile":41002.4,"90th_percentile":41002.4,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Headaches Without Mcc","code_information":[{"code":"103","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8084.5,"maximum":14828.34,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11263.45},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8084.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8084.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10964.25},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11305.58},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11867.19},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8084.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8084.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":12899.12},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8084.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8084.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8084.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8084.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8084.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8084.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8084.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14828.34},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13544.54},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8084.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6828.57,"10th_percentile":6828.57,"90th_percentile":6828.57,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":24496.42,"10th_percentile":24257.33,"90th_percentile":25459.72,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27568.93,"10th_percentile":26729.14,"90th_percentile":63573.81,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":5390.63,"10th_percentile":5390.63,"90th_percentile":5390.63,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"19","median_amount":26607.51,"10th_percentile":14534.64,"90th_percentile":52013.5,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":8380.29,"10th_percentile":8380.29,"90th_percentile":8380.29},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":34518.23,"10th_percentile":34518.23,"90th_percentile":34518.23,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6832.47,"10th_percentile":6832.47,"90th_percentile":6832.47,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":5491.09,"10th_percentile":5491.09,"90th_percentile":5491.09,"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":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":14828.34,"10th_percentile":14828.34,"90th_percentile":14828.34,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5005.78,"10th_percentile":4999.94,"90th_percentile":6093.58,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Headaches With Mcc","code_information":[{"code":"102","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10656.26,"maximum":20221.1,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15359.73},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10656.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10656.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14951.72},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":15417.18},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16183.03},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10656.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10656.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":17590.25},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10656.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10656.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10656.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10656.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10656.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10656.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10656.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20221.1},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18470.4},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10656.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":37870.94,"10th_percentile":37870.94,"90th_percentile":37870.94,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Seizures Without Mcc","code_information":[{"code":"101","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8683.61,"maximum":16073.63,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12209.36},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8683.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8683.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11885.03},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":12255.02},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12863.79},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8683.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8683.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":13982.39},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8683.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8683.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8683.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8683.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8683.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8683.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8683.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16073.63},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14682.01},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8683.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11957.64,"10th_percentile":11101.98,"90th_percentile":18513.91,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":5412.93,"10th_percentile":5412.93,"90th_percentile":5473.75,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7364.31,"10th_percentile":6298.66,"90th_percentile":7398.11,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":21754.89,"10th_percentile":21754.89,"90th_percentile":34146.3,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27813.24,"10th_percentile":10811.53,"90th_percentile":38606.9,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":4397.97,"10th_percentile":1182.15,"90th_percentile":4397.97,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7364.31,"10th_percentile":7364.31,"90th_percentile":7364.31,"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":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"23","median_amount":17510.86,"10th_percentile":8808.65,"90th_percentile":38548.22,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":12297.88,"10th_percentile":12297.88,"90th_percentile":12297.88},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":3770.09,"10th_percentile":3190.06,"90th_percentile":8049.36,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7485.82,"10th_percentile":7485.82,"90th_percentile":7485.82,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5728.18,"10th_percentile":5728.18,"90th_percentile":5728.18,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient 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":3389.78,"10th_percentile":1122.57,"90th_percentile":5656.69,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":5521.19,"10th_percentile":5521.19,"90th_percentile":5521.19,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":16075.37,"10th_percentile":16075.37,"90th_percentile":16075.37,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5876.94,"10th_percentile":194.67,"90th_percentile":7403.81,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Seizures With Mcc","code_information":[{"code":"100","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18029.09,"maximum":34623.87,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26299.93},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18029.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18029.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25601.3},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":26398.3},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27709.64},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18029.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18029.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":30119.18},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18029.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18029.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18029.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18029.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18029.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18029.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18029.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34623.87},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31626.22},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18029.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7370.66,"10th_percentile":7370.66,"90th_percentile":15434.44,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13784.66,"10th_percentile":13784.66,"90th_percentile":13784.66,"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":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":6490.69,"10th_percentile":6365.93,"90th_percentile":12560.03,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":44693.15,"10th_percentile":32847.22,"90th_percentile":90559.17,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7734.88,"10th_percentile":7734.88,"90th_percentile":7734.88,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":3358.46,"10th_percentile":3358.46,"90th_percentile":3358.46,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15433.26,"10th_percentile":15433.26,"90th_percentile":15433.26,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":4397.97,"10th_percentile":4397.97,"90th_percentile":4397.97,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14271.56,"10th_percentile":7370.66,"90th_percentile":15785.47,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/Mcc","code_information":[{"code":"099","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12838.56,"maximum":24298.8,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18457.11},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12838.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12838.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17966.82},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":18526.15},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19446.44},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12838.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12838.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":21137.44},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12838.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12838.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12838.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12838.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12838.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12838.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12838.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24298.8},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22195.07},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12838.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":48382.61,"10th_percentile":48382.61,"90th_percentile":48382.61,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":5599.32,"10th_percentile":5599.32,"90th_percentile":5599.32,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":42807.43,"10th_percentile":42807.43,"90th_percentile":42807.43,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc","code_information":[{"code":"098","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21265.03,"maximum":37831.27,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28736.24},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21265.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21265.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27972.89},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":28843.72},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30276.54},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21265.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21265.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":32909.28},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21265.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21265.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21265.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21265.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21265.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21265.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21265.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37831.27},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34555.93},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21265.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16347.23,"10th_percentile":16347.23,"90th_percentile":16347.23,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":99105.8,"10th_percentile":99105.8,"90th_percentile":99105.8,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10762.78,"10th_percentile":10762.78,"90th_percentile":10762.78,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":34701.29,"10th_percentile":34701.29,"90th_percentile":34701.29,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":33165.11,"maximum":62522.5,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47491.43},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33165.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33165.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":46229.87},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":47669.06},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":50037.03},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33165.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33165.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":54388.08},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33165.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33165.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33165.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33165.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33165.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33165.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33165.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62522.5},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":57109.45},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33165.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":35597.24,"10th_percentile":35597.24,"90th_percentile":35597.24,"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":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":70056.13,"10th_percentile":70056.13,"90th_percentile":70056.13,"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":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27620.28,"10th_percentile":27620.28,"90th_percentile":27620.28,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bacterial And Tuberculous Infections Of Nervous System Without Cc/Mcc","code_information":[{"code":"096","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23834.09,"maximum":41806.08,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31755.46},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23834.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23834.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30911.9},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":31874.23},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33457.59},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23834.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23834.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":36366.95},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23834.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23834.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23834.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23834.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23834.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23834.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23834.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41806.08},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38186.61},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23834.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":13429.46,"10th_percentile":13429.46,"90th_percentile":13429.46,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":138717.75,"10th_percentile":138717.75,"90th_percentile":138717.75,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18552.5,"10th_percentile":18552.5,"90th_percentile":18552.5,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":13429.46,"10th_percentile":13429.46,"90th_percentile":13429.46,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":23834.09,"maximum":41806.08,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31755.46},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23834.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23834.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30911.9},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":31874.23},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33457.59},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23834.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23834.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":36366.95},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23834.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23834.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23834.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23834.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23834.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23834.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23834.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41806.08},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38186.61},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23834.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":31608.11,"10th_percentile":31608.11,"90th_percentile":31608.11,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20429.38,"10th_percentile":20429.38,"90th_percentile":20429.38,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":17396.65,"10th_percentile":17396.65,"90th_percentile":17396.65,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bacterial And Tuberculous Infections Of Nervous System With Mcc","code_information":[{"code":"094","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32330.14,"maximum":63631.74,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48334.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32330.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32330.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":47050.06},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":48514.78},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":50924.77},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32330.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32330.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":55353.01},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32330.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32330.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32330.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32330.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32330.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32330.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32330.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":63631.74},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":58122.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32330.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":31690.96,"10th_percentile":31690.96,"90th_percentile":31690.96,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":24466.78,"10th_percentile":24466.78,"90th_percentile":24466.78,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25408.49,"10th_percentile":25408.49,"90th_percentile":25408.49,"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 Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":7723.04,"maximum":13766.18,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10456.65},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7723.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7723.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10178.88},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":10495.76},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11017.14},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7723.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7723.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11975.15},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7723.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7723.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7723.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7723.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7723.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7723.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7723.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13766.18},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12574.34},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7723.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":6965.22,"10th_percentile":6965.22,"90th_percentile":6965.22,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6365.47,"10th_percentile":6365.47,"90th_percentile":6365.47,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4721.46,"10th_percentile":4721.46,"90th_percentile":4721.46,"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":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":6317.75,"10th_percentile":6317.75,"90th_percentile":6317.75,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5460.3,"10th_percentile":5460.3,"90th_percentile":5460.3,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":35153.91,"10th_percentile":20246.87,"90th_percentile":64556.55,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6664.58,"10th_percentile":6664.58,"90th_percentile":6664.58,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":1035.48,"10th_percentile":1035.48,"90th_percentile":1035.48,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":13766.18,"10th_percentile":13766.18,"90th_percentile":13766.18,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6361.42,"10th_percentile":6361.42,"90th_percentile":6361.42,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":9771.6,"maximum":18466.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14026.98},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9771.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9771.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13654.37},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":14079.45},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14778.85},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9771.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9771.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":16063.97},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9771.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9771.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9771.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9771.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9771.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9771.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9771.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18466.53},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16867.74},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9771.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12864.07,"10th_percentile":12864.07,"90th_percentile":13022.01,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":171.43,"10th_percentile":171.43,"90th_percentile":171.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6361.38,"10th_percentile":4004.79,"90th_percentile":8409.34,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":55680.04,"10th_percentile":55680.04,"90th_percentile":55680.04,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":29635.1,"10th_percentile":29635.1,"90th_percentile":29635.1,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":2998.11,"10th_percentile":2998.11,"90th_percentile":2998.11,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8408.7,"10th_percentile":8408.7,"90th_percentile":8408.7,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8157.06,"10th_percentile":8157.06,"90th_percentile":8157.06,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":50398.02,"10th_percentile":39722.25,"90th_percentile":128694.82,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":4217.35,"10th_percentile":4217.35,"90th_percentile":9027.17,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8415.45,"10th_percentile":8019.84,"90th_percentile":8417.64,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":5218.82,"10th_percentile":5218.82,"90th_percentile":5218.82,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6206.58,"10th_percentile":6206.58,"90th_percentile":6206.58,"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 Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":18464.79,"10th_percentile":18464.79,"90th_percentile":18464.79,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6586.55,"10th_percentile":2617.14,"90th_percentile":8417.04,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":16397.11,"maximum":31791.45,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24148.45},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16397.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16397.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23506.97},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":24238.77},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25442.84},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16397.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16397.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":27655.27},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16397.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16397.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16397.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16397.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16397.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16397.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16397.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31791.45},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29039.03},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16397.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14347.9,"10th_percentile":14347.9,"90th_percentile":14347.9,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":9781.13,"10th_percentile":9781.13,"90th_percentile":9781.13,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":84548.64,"10th_percentile":84548.64,"90th_percentile":84548.64,"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":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12394.85,"10th_percentile":12394.85,"90th_percentile":12394.85,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13908.42,"10th_percentile":13908.42,"90th_percentile":13958.68,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12678.33,"10th_percentile":12678.33,"90th_percentile":12678.33,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":13860.61,"10th_percentile":13860.61,"90th_percentile":13860.61,"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":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":14553.41,"10th_percentile":14553.41,"90th_percentile":14553.41,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12379.31,"10th_percentile":4538.62,"90th_percentile":14075.45,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":7966.12,"maximum":14950.43,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11356.19},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7966.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7966.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11054.52},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11398.66},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11964.89},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7966.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7966.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":13005.32},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7966.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7966.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7966.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7966.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7966.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7966.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7966.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14950.43},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13656.05},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7966.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concussion With Cc","code_information":[{"code":"089","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10454.75,"maximum":18698.5,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14203.18},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10454.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10454.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13825.89},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":14256.3},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14964.49},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10454.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10454.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":16265.75},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10454.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10454.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10454.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10454.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10454.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10454.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10454.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18698.5},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17079.63},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10454.75,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8516.36,"10th_percentile":8516.36,"90th_percentile":8516.36,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concussion With Mcc","code_information":[{"code":"088","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12742.78,"maximum":24602.27,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18687.63},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12742.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12742.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18191.21},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":18757.52},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19689.31},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12742.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12742.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":21401.43},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12742.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12742.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12742.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12742.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12742.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12742.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12742.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24602.27},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22472.27},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12742.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10237.76,"10th_percentile":10237.76,"90th_percentile":10237.76,"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 Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma <1 Hour Without Cc/Mcc","code_information":[{"code":"087","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8792.95,"maximum":15417.84,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11711.23},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8792.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8792.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11400.13},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11755.03},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12338.97},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8792.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8792.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":13411.92},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8792.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8792.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8792.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8792.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8792.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8792.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8792.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15417.84},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14083.0},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8792.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1021.68,"10th_percentile":1021.68,"90th_percentile":1021.68,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":24779.69,"10th_percentile":24779.69,"90th_percentile":24779.69,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma <1 Hour With Cc","code_information":[{"code":"086","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12299.09,"maximum":22875.62,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17376.08},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12299.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12299.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16914.5},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":17441.07},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18307.46},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12299.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12299.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":19899.41},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12299.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12299.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12299.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12299.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12299.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12299.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12299.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22875.62},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20895.1},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12299.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17376.08,"10th_percentile":17376.08,"90th_percentile":17376.08,"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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9987.02,"10th_percentile":7134.89,"90th_percentile":10326.73,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30463.61,"10th_percentile":30463.61,"90th_percentile":30463.61,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10008.31,"10th_percentile":10008.31,"90th_percentile":10008.31,"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":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10163.16,"10th_percentile":10163.16,"90th_percentile":10163.16,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":15419.64,"10th_percentile":15419.64,"90th_percentile":15419.64,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":22183.28,"10th_percentile":22183.28,"90th_percentile":22183.28,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10331.74,"10th_percentile":10331.74,"90th_percentile":10336.74,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma <1 Hour With Mcc","code_information":[{"code":"085","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21057.2,"maximum":39519.56,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30018.64},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21057.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21057.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29221.23},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":30130.92},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31627.68},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21057.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21057.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":34377.92},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21057.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21057.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21057.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21057.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21057.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21057.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21057.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39519.56},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36098.05},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21057.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":293.45,"10th_percentile":293.45,"90th_percentile":293.45,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17594.41,"10th_percentile":17594.41,"90th_percentile":18056.87,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26237.09,"10th_percentile":26237.09,"90th_percentile":26237.09,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma >1 Hour Without Cc/Mcc","code_information":[{"code":"084","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9164.35,"maximum":16673.6,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12665.09},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9164.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9164.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12328.65},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":12712.46},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13343.95},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9164.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9164.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":14504.3},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9164.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9164.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9164.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9164.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9164.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9164.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9164.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16673.6},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15230.04},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9164.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":12509.98,"10th_percentile":12509.98,"90th_percentile":12509.98,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma >1 Hour With Cc","code_information":[{"code":"083","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13140.38,"maximum":24248.22,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18418.69},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13140.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13140.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17929.42},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":18487.58},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19405.96},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13140.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13140.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":21093.44},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13140.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13140.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13140.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13140.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13140.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13140.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13140.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24248.22},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22148.87},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13140.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18420.02,"10th_percentile":18420.02,"90th_percentile":18491.56,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":18380.55,"10th_percentile":18380.55,"90th_percentile":18380.55,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10923.32,"10th_percentile":10923.32,"90th_percentile":10923.32,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":43347.77,"10th_percentile":43347.77,"90th_percentile":43347.77,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10952.97,"10th_percentile":10952.97,"90th_percentile":10952.97,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10350.02,"10th_percentile":10350.02,"90th_percentile":10934.07,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":26082.14,"10th_percentile":26082.14,"90th_percentile":26082.14,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10364.23,"10th_percentile":10364.23,"90th_percentile":10914.58,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma >1 Hour With Mcc","code_information":[{"code":"082","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21180.99,"maximum":40464.86,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30736.68},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21180.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21180.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29920.2},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":30851.65},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32384.21},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21180.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21180.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":35200.23},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21180.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21180.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21180.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21180.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21180.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21180.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21180.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40464.86},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36961.51},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21180.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17973.53,"10th_percentile":16646.24,"90th_percentile":17973.53,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":92342.44,"10th_percentile":92342.44,"90th_percentile":92342.44,"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":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":21017.96,"10th_percentile":21017.96,"90th_percentile":21017.96,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":231616.7,"10th_percentile":231616.7,"90th_percentile":231616.7,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17780.47,"10th_percentile":17780.47,"90th_percentile":17780.47,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":17501.73,"10th_percentile":17501.73,"90th_percentile":17501.73,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17974.64,"10th_percentile":17974.64,"90th_percentile":18064.67,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":8620.36,"maximum":15780.62,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11986.79},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8620.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8620.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11668.37},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":12031.62},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12629.3},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8620.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8620.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":13727.5},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8620.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8620.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8620.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8620.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8620.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8620.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8620.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15780.62},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14414.37},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8620.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":22634.44,"10th_percentile":22634.44,"90th_percentile":22634.44,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Nontraumatic Stupor And Coma With Mcc","code_information":[{"code":"080","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16883.27,"maximum":34669.22,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26334.37},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16883.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16883.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25634.83},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":26432.87},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27745.93},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16883.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16883.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":30158.62},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16883.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16883.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16883.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16883.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16883.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16883.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16883.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34669.22},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31667.64},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16883.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15483.31,"10th_percentile":15483.31,"90th_percentile":15483.31,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertensive Encephalopathy Without Cc/Mcc","code_information":[{"code":"079","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8597.82,"maximum":11627.91,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8832.44},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8597.82},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":8865.48},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9305.87},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10115.08},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11627.91},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10621.2}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":8038.26,"10th_percentile":8038.26,"90th_percentile":8038.26,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertensive Encephalopathy With Cc","code_information":[{"code":"078","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12867.71,"maximum":17402.63,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13218.85},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12867.71},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":13268.3},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13927.4},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":15138.48},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17402.63},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15895.95}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7960.73,"10th_percentile":7960.73,"90th_percentile":7960.73,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7947.78,"10th_percentile":7947.78,"90th_percentile":7947.78,"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":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":801.32,"10th_percentile":801.32,"90th_percentile":801.32,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertensive Encephalopathy With Mcc","code_information":[{"code":"077","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19939.92,"maximum":26967.27,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20484.06},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19939.92},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":20560.67},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21582.03},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":23458.73},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26967.27},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24632.51}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Viral Meningitis Without Cc/Mcc","code_information":[{"code":"076","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7984.19,"maximum":15991.65,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12147.09},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7984.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7984.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11824.42},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":12192.52},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12798.19},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7984.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7984.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":13911.08},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7984.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7984.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7984.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7984.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7984.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7984.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7984.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15991.65},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14607.13},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7984.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":29831.17,"10th_percentile":29831.17,"90th_percentile":29831.17,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":1513.0,"10th_percentile":1513.0,"90th_percentile":1513.0,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Viral Meningitis With Cc/Mcc","code_information":[{"code":"075","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17854.68,"maximum":30040.38,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22818.36},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17854.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17854.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22212.21},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":22903.7},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24041.45},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17854.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17854.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":26132.01},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17854.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17854.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17854.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17854.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17854.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17854.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17854.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30040.38},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27439.55},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17854.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18718.12,"10th_percentile":18718.12,"90th_percentile":18718.12,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cranial And Peripheral Nerve Disorders Without Mcc","code_information":[{"code":"074","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9842.08,"maximum":18180.5,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13809.72},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9842.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9842.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13442.87},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":13861.37},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14549.93},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9842.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9842.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":15815.15},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9842.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9842.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9842.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9842.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9842.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9842.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9842.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18180.5},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16606.47},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9842.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13836.77,"10th_percentile":13836.77,"90th_percentile":13836.77,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":1039.15,"10th_percentile":1039.15,"90th_percentile":1039.15,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8286.91,"10th_percentile":8286.91,"90th_percentile":8286.91,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6832.54,"10th_percentile":6832.54,"90th_percentile":6832.54,"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":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":75515.16,"10th_percentile":75515.16,"90th_percentile":75515.16,"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":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":31491.34,"10th_percentile":31491.34,"90th_percentile":73987.21,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":4496.43,"10th_percentile":4496.43,"90th_percentile":4496.43,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8285.74,"10th_percentile":8285.74,"90th_percentile":8285.74,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8037.17,"10th_percentile":8037.17,"90th_percentile":8037.17,"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":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"11","median_amount":26599.58,"10th_percentile":18815.7,"90th_percentile":46143.94,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":34612.59,"10th_percentile":34612.59,"90th_percentile":34612.59},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient 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":5272.3,"10th_percentile":3866.25,"90th_percentile":5838.23,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7541.33,"10th_percentile":7342.82,"90th_percentile":8303.92,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":5747.63,"10th_percentile":5747.63,"90th_percentile":5747.63,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6085.72,"10th_percentile":6085.72,"90th_percentile":6085.72,"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":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":163.55,"10th_percentile":163.55,"90th_percentile":163.55,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":18180.5,"10th_percentile":15068.55,"90th_percentile":18180.5,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6652.23,"10th_percentile":6652.23,"90th_percentile":8475.03,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":15024.47,"maximum":26955.07,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20474.78},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15024.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15024.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19930.89},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":20551.36},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21572.26},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15024.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15024.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":23448.11},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15024.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15024.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15024.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15024.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15024.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15024.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15024.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26955.07},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24621.36},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15024.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":4859.44,"10th_percentile":4859.44,"90th_percentile":4859.44,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7555.48,"10th_percentile":7555.48,"90th_percentile":7555.48,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":249922.76,"10th_percentile":249922.76,"90th_percentile":249922.76,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11736.9,"10th_percentile":11736.9,"90th_percentile":11736.9,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":43219.03,"10th_percentile":30237.16,"90th_percentile":45674.03,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12100.82,"10th_percentile":12100.82,"90th_percentile":12131.8,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":7416.41,"10th_percentile":7416.41,"90th_percentile":7416.41,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":1444.0,"10th_percentile":1444.0,"90th_percentile":1444.0,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12127.39,"10th_percentile":12127.39,"90th_percentile":12127.39,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":7360.68,"maximum":13082.49,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9937.32},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7360.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7360.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9673.35},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":9974.49},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10469.98},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7360.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7360.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11380.41},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7360.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7360.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7360.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7360.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7360.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7360.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7360.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13082.49},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11949.84},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7360.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24051.03,"10th_percentile":24051.03,"90th_percentile":24051.03,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6081.76,"10th_percentile":6081.76,"90th_percentile":6081.76,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":9798.71,"maximum":18379.33,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13960.74},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9798.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9798.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13589.89},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":14012.96},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14709.06},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9798.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9798.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":15988.11},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9798.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9798.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9798.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9798.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9798.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9798.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9798.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18379.33},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16788.09},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9798.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":40006.49,"10th_percentile":40006.49,"90th_percentile":40006.49,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9621.93,"10th_percentile":9621.93,"90th_percentile":9621.93,"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":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":44679.73,"10th_percentile":36346.06,"90th_percentile":64443.77,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8437.97,"10th_percentile":8437.97,"90th_percentile":8437.97,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":5842.47,"10th_percentile":5842.47,"90th_percentile":5842.47,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6542.9,"10th_percentile":6436.83,"90th_percentile":12895.42,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":15571.18,"maximum":30324.67,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23034.3},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15571.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15571.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22422.41},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":23120.45},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24268.97},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15571.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15571.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":26379.31},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15571.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15571.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15571.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15571.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15571.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15571.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15571.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30324.67},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27699.23},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15571.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":43393.32,"10th_percentile":43393.32,"90th_percentile":43393.32,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12584.53,"10th_percentile":12584.53,"90th_percentile":12584.53,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13704.94,"10th_percentile":13704.94,"90th_percentile":13704.94,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11248.75,"10th_percentile":11248.75,"90th_percentile":11248.75,"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 Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":14069.97,"10th_percentile":14069.97,"90th_percentile":14069.97,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13369.79,"10th_percentile":10684.35,"90th_percentile":13565.6,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":7745.63,"maximum":13956.29,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10601.05},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7745.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7745.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10319.44},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":10640.7},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11169.28},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7745.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7745.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":12140.52},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7745.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7745.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7745.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7745.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7745.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7745.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7745.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13956.29},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12747.99},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7745.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":311.03,"10th_percentile":311.03,"90th_percentile":311.03,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":33229.39,"10th_percentile":33229.39,"90th_percentile":33229.39,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6460.78,"10th_percentile":6460.78,"90th_percentile":6460.78,"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":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":285.67,"10th_percentile":285.67,"90th_percentile":285.67,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6198.22,"10th_percentile":2457.77,"90th_percentile":6451.42,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":8338.42,"maximum":15375.99,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11679.44},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8338.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8338.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11369.18},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11723.12},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12305.47},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8338.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8338.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":13375.51},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8338.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8338.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8338.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8338.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8338.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8338.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8338.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15375.99},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14044.77},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8338.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":5418.37,"10th_percentile":5418.37,"90th_percentile":5418.37,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":233.87,"10th_percentile":233.87,"90th_percentile":233.87,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Precerebral Occlusion Without Infarction With Mcc","code_information":[{"code":"067","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13799.13,"maximum":25390.61,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19286.44},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13799.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13799.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18774.11},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":19358.57},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20320.22},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13799.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13799.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":22087.19},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13799.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13799.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13799.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13799.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13799.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13799.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13799.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25390.61},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23192.35},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13799.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc","code_information":[{"code":"066","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6711.86,"maximum":12004.64,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9118.6},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6711.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6711.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8876.37},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":9152.7},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9607.37},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6711.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6711.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10442.79},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6711.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6711.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6711.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6711.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6711.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6711.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6711.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12004.64},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10965.31},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6711.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9118.6,"10th_percentile":8466.09,"90th_percentile":9118.6,"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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":10150.57,"10th_percentile":10150.57,"90th_percentile":10150.57,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5377.7,"10th_percentile":4962.41,"90th_percentile":5815.09,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":67288.99,"10th_percentile":67288.99,"90th_percentile":67288.99,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":28539.89,"10th_percentile":28539.89,"90th_percentile":28539.89,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":1337.73,"10th_percentile":1337.73,"90th_percentile":1337.73,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5613.12,"10th_percentile":5282.62,"90th_percentile":5620.66,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":40299.44,"10th_percentile":26864.08,"90th_percentile":294245.62,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":16347.79,"10th_percentile":16347.79,"90th_percentile":16347.79},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":5032.99,"10th_percentile":5032.99,"90th_percentile":5032.99,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5044.53,"10th_percentile":5044.53,"90th_percentile":5044.53,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5601.9,"10th_percentile":4763.37,"90th_percentile":5808.89,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":5528.81,"10th_percentile":5528.81,"90th_percentile":5528.81,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":6904.94,"10th_percentile":6904.94,"90th_percentile":6904.94,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":10228.14,"10th_percentile":10228.14,"90th_percentile":10228.14,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5605.09,"10th_percentile":5596.37,"90th_percentile":5608.6,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":9656.84,"maximum":17737.5,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13473.22},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9656.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9656.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13115.31},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":13523.61},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14195.4},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9656.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9656.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":15429.78},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9656.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9656.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9656.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9656.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9656.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9656.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9656.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17737.5},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16201.83},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9656.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13471.89,"10th_percentile":13046.89,"90th_percentile":13471.89,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":7093.37,"10th_percentile":7093.37,"90th_percentile":7093.37,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"14","median_amount":7792.51,"10th_percentile":5600.7,"90th_percentile":8351.56,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6262.62,"10th_percentile":6262.62,"90th_percentile":6262.62,"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":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":66090.84,"10th_percentile":66090.84,"90th_percentile":162757.8,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":47533.18,"10th_percentile":32857.94,"90th_percentile":66258.15,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":6769.55,"10th_percentile":6769.55,"90th_percentile":6769.55,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8092.42,"10th_percentile":5890.21,"90th_percentile":8107.73,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"16","median_amount":45261.6,"10th_percentile":33325.18,"90th_percentile":69339.52,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":12913.89,"10th_percentile":12913.89,"90th_percentile":12913.89},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7798.42,"10th_percentile":7798.42,"90th_percentile":7798.42,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":6159.0,"10th_percentile":6159.0,"90th_percentile":6553.93,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"13","median_amount":7512.11,"10th_percentile":6156.3,"90th_percentile":8196.01,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6674.28,"10th_percentile":6674.28,"90th_percentile":6674.28,"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":"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":5877.53,"10th_percentile":1171.99,"90th_percentile":6159.0,"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":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6476.37,"10th_percentile":6476.37,"90th_percentile":6476.37,"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 Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":17026.32,"10th_percentile":17026.32,"90th_percentile":17026.32,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"1 through 10","median_amount":13888.18,"10th_percentile":13888.18,"90th_percentile":13888.18,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"11","median_amount":8100.42,"10th_percentile":6269.62,"90th_percentile":8326.77,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":18699.59,"maximum":34691.89,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26351.6},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18699.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18699.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25651.59},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":26450.16},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27764.08},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18699.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18699.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":30178.35},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18699.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18699.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18699.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18699.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18699.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18699.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18699.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34691.89},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31688.35},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18699.59,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8770.07,"10th_percentile":8770.07,"90th_percentile":8770.07,"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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":10463.63,"10th_percentile":10463.63,"90th_percentile":13325.79,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15462.33,"10th_percentile":5605.26,"90th_percentile":16042.61,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":52191.1,"10th_percentile":52191.1,"90th_percentile":52191.1,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":248640.08,"10th_percentile":248640.08,"90th_percentile":248640.08,"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":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":6769.55,"10th_percentile":6769.55,"90th_percentile":6769.55,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15450.33,"10th_percentile":15268.03,"90th_percentile":30194.48,"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":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15561.33,"10th_percentile":15561.33,"90th_percentile":16505.5,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":90829.01,"10th_percentile":44762.12,"90th_percentile":105164.52,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":11272.41,"10th_percentile":11272.41,"90th_percentile":64270.88},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13610.83,"10th_percentile":13610.83,"90th_percentile":15780.5,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":12109.02,"10th_percentile":8148.8,"90th_percentile":19533.93,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"19","median_amount":14494.83,"10th_percentile":12740.63,"90th_percentile":15493.97,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":8148.8,"10th_percentile":6769.55,"90th_percentile":43479.69,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13148.3,"10th_percentile":13148.3,"90th_percentile":13148.3,"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":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":34198.33,"10th_percentile":31062.69,"90th_percentile":34693.64,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"13","median_amount":15365.39,"10th_percentile":12650.94,"90th_percentile":15851.73,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/Mcc","code_information":[{"code":"063","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13212.67,"maximum":24499.37,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18609.47},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13212.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13212.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18115.12},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":18679.07},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19606.96},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13212.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13212.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":21311.91},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13212.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13212.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13212.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13212.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13212.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13212.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13212.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24499.37},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22378.28},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13212.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11070.26,"10th_percentile":11070.26,"90th_percentile":11070.26,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":6769.55,"10th_percentile":6769.55,"90th_percentile":6769.55,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc","code_information":[{"code":"062","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16406.14,"maximum":31058.93,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23592.04},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16406.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16406.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22965.34},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":23680.28},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24856.6},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16406.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16406.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":27018.05},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16406.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16406.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16406.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16406.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16406.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16406.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16406.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31058.93},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28369.92},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16406.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13900.44,"10th_percentile":13900.44,"90th_percentile":13900.44,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":92949.68,"10th_percentile":92949.68,"90th_percentile":92949.68,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":75383.34,"10th_percentile":75383.34,"90th_percentile":75383.34,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13120.38,"10th_percentile":13120.38,"90th_percentile":13120.38,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":6904.94,"10th_percentile":6904.94,"90th_percentile":6904.94,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":5032.99,"10th_percentile":5032.99,"90th_percentile":5032.99,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"1 through 10","median_amount":24684.32,"10th_percentile":24684.32,"90th_percentile":24684.32,"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":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13887.52,"10th_percentile":13887.52,"90th_percentile":13887.52,"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":"Youthcare","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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19217.65,"10th_percentile":19217.65,"90th_percentile":19217.65,"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":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20870.18,"10th_percentile":20870.18,"90th_percentile":20870.18,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":8839.04,"maximum":15564.35,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11822.52},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8839.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8839.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11508.46},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11866.73},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12456.22},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8839.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8839.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":13539.37},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8839.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8839.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8839.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8839.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8839.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8839.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8839.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15564.35},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14216.82},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8839.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11822.52,"10th_percentile":11822.52,"90th_percentile":11822.52,"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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23122.27,"10th_percentile":23122.27,"90th_percentile":23122.27,"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":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":20734.07,"10th_percentile":20734.07,"90th_percentile":28560.19,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":9643.52,"10th_percentile":9643.52,"90th_percentile":9643.52},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7162.91,"10th_percentile":7162.91,"90th_percentile":7162.91,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":15564.35,"10th_percentile":15564.35,"90th_percentile":15564.35,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":11740.64,"maximum":21339.06,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16208.93},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11740.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11740.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15778.35},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":16269.55},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17077.75},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11740.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11740.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":18562.77},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11740.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11740.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11740.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11740.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11740.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11740.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11740.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21339.06},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19491.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11740.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":6749.7,"10th_percentile":6749.7,"90th_percentile":6749.7,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8965.08,"10th_percentile":8965.08,"90th_percentile":8965.08,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":6749.7,"10th_percentile":6749.7,"90th_percentile":6749.7,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1322.61,"10th_percentile":1322.61,"90th_percentile":1322.61,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":40797.68,"10th_percentile":40797.68,"90th_percentile":40797.68,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":7428.76,"10th_percentile":7428.76,"90th_percentile":7428.76,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":6434.12,"10th_percentile":6434.12,"90th_percentile":6434.12,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":15975.11,"maximum":32190.85,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24451.83},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15975.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15975.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23802.29},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":24543.29},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25762.48},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15975.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15975.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":28002.7},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15975.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15975.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15975.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15975.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15975.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15975.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15975.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32190.85},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29403.85},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15975.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14405.36,"10th_percentile":14405.36,"90th_percentile":14405.36,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":20723.99,"10th_percentile":20723.99,"90th_percentile":20723.99,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Degenerative Nervous System Disorders Without Mcc","code_information":[{"code":"057","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12234.93,"maximum":23278.5,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17682.11},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12234.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12234.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17212.4},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":17748.24},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18629.89},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12234.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12234.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":20249.88},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12234.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12234.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12234.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12234.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12234.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12234.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12234.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23278.5},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21263.11},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12234.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":8392.76,"10th_percentile":8392.76,"90th_percentile":8392.76,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"11","median_amount":10498.79,"10th_percentile":10490.35,"90th_percentile":10519.41,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":91508.82,"10th_percentile":91508.82,"90th_percentile":91508.82,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":21476.4,"10th_percentile":21476.4,"90th_percentile":21476.4,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8414.49,"10th_percentile":8414.49,"90th_percentile":8414.49,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":37631.85,"10th_percentile":33549.51,"90th_percentile":77033.72,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1136.78,"10th_percentile":1136.78,"90th_percentile":1136.78,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8369.99,"10th_percentile":7776.26,"90th_percentile":12302.04,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":5778.79,"10th_percentile":209.48,"90th_percentile":7013.0,"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":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8293.7,"10th_percentile":8293.7,"90th_percentile":8293.7,"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":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":23273.27,"10th_percentile":20620.61,"90th_percentile":23273.27,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10192.55,"10th_percentile":285.67,"90th_percentile":10519.41,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Degenerative Nervous System Disorders With Mcc","code_information":[{"code":"056","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21519.86,"maximum":43672.26,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33172.99},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21519.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21519.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32291.78},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":33297.07},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34951.11},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21519.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21519.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":37990.34},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21519.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21519.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21519.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21519.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21519.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21519.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21519.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43672.26},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39891.22},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21519.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19366.29,"10th_percentile":19366.29,"90th_percentile":19366.29,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12011.05,"10th_percentile":12011.05,"90th_percentile":19350.55,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19573.28,"10th_percentile":19573.28,"90th_percentile":19573.28,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":7856.73,"10th_percentile":7856.73,"90th_percentile":7856.73,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":42827.95,"10th_percentile":42827.95,"90th_percentile":42827.95,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19350.56,"10th_percentile":14378.92,"90th_percentile":19411.29,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Nervous System Neoplasms Without Mcc","code_information":[{"code":"055","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9740.87,"maximum":19026.39,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14452.24},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9740.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9740.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14068.33},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":14506.3},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15226.9},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9740.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9740.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":16550.98},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9740.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9740.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9740.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9740.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9740.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9740.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9740.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19026.39},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17379.13},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9740.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8646.73,"10th_percentile":8646.73,"90th_percentile":8646.73,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8393.96,"10th_percentile":8393.96,"90th_percentile":8393.96,"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":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":46427.58,"10th_percentile":26330.71,"90th_percentile":177098.85,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":6345.09,"10th_percentile":6345.09,"90th_percentile":6345.09,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Nervous System Neoplasms With Mcc","code_information":[{"code":"054","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14325.05,"maximum":26145.8,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19860.08},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14325.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14325.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19332.51},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":19934.36},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20924.6},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14325.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14325.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":22744.14},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14325.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14325.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14325.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14325.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14325.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14325.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14325.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26145.8},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23882.16},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14325.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":4110.77,"10th_percentile":4110.77,"90th_percentile":4110.77,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11737.96,"10th_percentile":11737.96,"90th_percentile":11737.96,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":51645.47,"10th_percentile":51645.47,"90th_percentile":51645.47,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":7171.39,"10th_percentile":7171.39,"90th_percentile":7171.39,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8899.13,"10th_percentile":8899.13,"90th_percentile":8899.13,"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":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":28772.44,"10th_percentile":28772.44,"90th_percentile":45381.32,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":6517.73,"10th_percentile":6517.73,"90th_percentile":6517.73,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":25579.26,"10th_percentile":25579.26,"90th_percentile":25579.26,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12305.14,"10th_percentile":12305.14,"90th_percentile":12305.14,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Disorders And Injuries Without Cc/Mcc","code_information":[{"code":"053","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9375.8,"maximum":16068.39,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12205.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9375.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9375.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11881.16},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":12251.03},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12859.61},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9375.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9375.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":13977.83},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9375.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9375.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9375.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9375.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9375.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9375.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9375.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16068.39},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14677.23},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9375.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Disorders And Injuries With Cc/Mcc","code_information":[{"code":"052","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16895.02,"maximum":35098.27,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26660.28},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16895.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16895.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25952.07},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":26759.99},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28089.3},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16895.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16895.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":30531.85},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16895.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16895.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16895.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16895.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16895.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16895.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16895.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35098.27},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32059.54},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16895.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/Mcc","code_information":[{"code":"042","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16139.57,"maximum":30652.56,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23283.36},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16139.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16139.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22664.86},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":23370.44},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24531.38},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16139.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16139.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":26664.54},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16139.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16139.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16139.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16139.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16139.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16139.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16139.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30652.56},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27998.73},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16139.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":90555.45,"10th_percentile":90555.45,"90th_percentile":90555.45,"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":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":69378.21,"10th_percentile":69378.21,"90th_percentile":69378.21,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":34730.48,"10th_percentile":34730.48,"90th_percentile":34730.48},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12042.11,"10th_percentile":12042.11,"90th_percentile":12042.11,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":30654.3,"10th_percentile":30654.3,"90th_percentile":30654.3,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator","code_information":[{"code":"041","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20395.73,"maximum":39392.24,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29921.93},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20395.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20395.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29127.09},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":30033.85},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31525.79},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20395.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20395.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":34267.16},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20395.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20395.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20395.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20395.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20395.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20395.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20395.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39392.24},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35981.76},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20395.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22378.86,"10th_percentile":22378.86,"90th_percentile":22378.86,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":130134.17,"10th_percentile":130134.17,"90th_percentile":130134.17,"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":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":43944.44,"10th_percentile":43944.44,"90th_percentile":43944.44,"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":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":36834.38,"10th_percentile":36834.38,"90th_percentile":36834.38,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13718.11,"10th_percentile":13718.11,"90th_percentile":13718.11,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc","code_information":[{"code":"040","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":35418.79,"maximum":65783.96,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49968.81},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35418.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35418.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":48641.43},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":50155.7},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":52647.2},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35418.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35418.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":57225.22},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35418.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35418.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35418.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35418.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35418.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35418.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35418.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":65783.96},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":60088.55},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35418.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":51153.18,"10th_percentile":51153.18,"90th_percentile":51153.18,"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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":86547.92,"10th_percentile":86547.92,"90th_percentile":86547.92,"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":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":221476.99,"10th_percentile":221476.99,"90th_percentile":221476.99,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extracranial Procedures Without Cc/Mcc","code_information":[{"code":"039","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11149.65,"maximum":19851.35,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15078.87},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11149.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11149.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14678.32},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":15135.27},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15887.12},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11149.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11149.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":17268.61},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11149.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11149.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11149.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11149.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11149.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11149.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11149.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19851.35},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18132.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11149.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9032.39,"10th_percentile":9032.39,"90th_percentile":9592.16,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8654.38,"10th_percentile":8654.38,"90th_percentile":8654.38,"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":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9019.98,"10th_percentile":9019.98,"90th_percentile":9019.98,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":8793.51,"10th_percentile":8793.51,"90th_percentile":8793.51,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9011.4,"10th_percentile":9011.4,"90th_percentile":9011.4,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extracranial Procedures With Cc","code_information":[{"code":"038","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15189.84,"maximum":28099.2,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21343.85},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15189.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15189.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20776.87},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":21423.68},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22487.91},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15189.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15189.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":24443.38},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15189.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15189.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15189.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15189.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15189.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15189.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15189.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28099.2},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25666.43},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15189.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9600.16,"10th_percentile":9600.16,"90th_percentile":9600.16,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":230356.58,"10th_percentile":230356.58,"90th_percentile":230356.58,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":10047.22,"10th_percentile":10047.22,"90th_percentile":10047.22,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12396.75,"10th_percentile":12396.75,"90th_percentile":12822.06,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12308.99,"10th_percentile":12308.99,"90th_percentile":12589.85,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extracranial Procedures With Mcc","code_information":[{"code":"037","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30276.16,"maximum":57916.33,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43992.63},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30276.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30276.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":42824.01},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":44157.17},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":46350.7},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30276.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30276.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":50381.2},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30276.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30276.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30276.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30276.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30276.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30276.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30276.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57916.33},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":52902.07},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30276.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":61805.37,"10th_percentile":61805.37,"90th_percentile":61805.37,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25574.45,"10th_percentile":25574.45,"90th_percentile":25574.45,"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":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25633.83,"10th_percentile":25633.83,"90th_percentile":25633.83,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Carotid Artery Stent Procedures Without Cc/Mcc","code_information":[{"code":"036","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18083.31,"maximum":31969.35,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24283.58},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18083.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18083.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23638.51},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":24374.41},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25585.22},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18083.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18083.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":27810.02},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18083.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18083.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18083.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18083.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18083.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18083.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18083.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31969.35},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29201.52},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18083.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10123.0,"10th_percentile":10123.0,"90th_percentile":10123.0,"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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15523.09,"10th_percentile":15523.09,"90th_percentile":15523.09,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":41702.66,"10th_percentile":41702.66,"90th_percentile":57851.43,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15133.89,"10th_percentile":15133.89,"90th_percentile":15133.89,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":3711.79,"10th_percentile":3711.79,"90th_percentile":3711.79,"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":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14317.75,"10th_percentile":14317.75,"90th_percentile":14317.75,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Carotid Artery Stent Procedures With Cc","code_information":[{"code":"035","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22128.92,"maximum":39671.3,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30133.9},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22128.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22128.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29333.42},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":30246.61},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31749.12},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22128.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22128.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":34509.91},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22128.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22128.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22128.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22128.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22128.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22128.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22128.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39671.3},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36236.65},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22128.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14279.43,"10th_percentile":14279.43,"90th_percentile":14279.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":58256.52,"10th_percentile":58256.52,"90th_percentile":58256.52,"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":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":102024.5,"10th_percentile":102024.5,"90th_percentile":102024.5,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12797.88,"10th_percentile":12797.88,"90th_percentile":12797.88,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14283.33,"10th_percentile":14283.33,"90th_percentile":18972.54,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16536.98,"10th_percentile":16536.98,"90th_percentile":16536.98,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":39674.79,"10th_percentile":39674.79,"90th_percentile":39674.79,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18972.54,"10th_percentile":18972.54,"90th_percentile":18972.54,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Carotid Artery Stent Procedures With Mcc","code_information":[{"code":"034","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":35504.64,"maximum":67819.33,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51514.85},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35504.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35504.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":50146.41},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":51707.52},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":54276.11},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35504.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35504.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":58995.78},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35504.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35504.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35504.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35504.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35504.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35504.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35504.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67819.33},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":61947.69},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35504.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":32810.2,"10th_percentile":32810.2,"90th_percentile":32810.2,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30400.33,"10th_percentile":30400.33,"90th_percentile":30400.33,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17620.77,"10th_percentile":17620.77,"90th_percentile":17620.77,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":29497.92,"10th_percentile":29497.92,"90th_percentile":29497.92,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular Shunt Procedures Without Cc/Mcc","code_information":[{"code":"033","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15554.01,"maximum":27825.37,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21135.86},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15554.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15554.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20574.41},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":21214.91},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22268.77},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15554.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15554.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":24205.19},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15554.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15554.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15554.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15554.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15554.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15554.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15554.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27825.37},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25416.32},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15554.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12478.18,"10th_percentile":12478.18,"90th_percentile":12478.18,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12484.08,"10th_percentile":12484.08,"90th_percentile":12484.08,"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":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":80863.14,"10th_percentile":80863.14,"90th_percentile":98871.87,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular Shunt Procedures With Cc","code_information":[{"code":"032","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19783.96,"maximum":37245.26,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28291.1},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19783.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19783.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27539.58},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":28396.92},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29807.54},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19783.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19783.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":32399.51},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19783.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19783.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19783.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19783.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19783.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19783.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19783.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37245.26},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34020.65},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19783.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":10894.8,"10th_percentile":10894.8,"90th_percentile":10894.8,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17308.46,"10th_percentile":17308.46,"90th_percentile":17308.46,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular Shunt Procedures With Mcc","code_information":[{"code":"031","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":41015.05,"maximum":73083.02,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55513.09},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41015.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41015.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":54038.44},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":55720.72},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":58488.67},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41015.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41015.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":63574.64},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41015.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41015.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41015.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41015.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41015.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41015.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41015.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":73083.02},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":66755.67},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41015.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":49718.97,"10th_percentile":49718.97,"90th_percentile":49718.97,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":35810.45,"10th_percentile":35810.45,"90th_percentile":35810.45,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":73088.25,"10th_percentile":73088.25,"90th_percentile":73088.25,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures Without Cc/Mcc","code_information":[{"code":"030","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20364.1,"maximum":38809.71,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29479.45},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20364.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20364.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28696.36},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":29589.71},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31059.59},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20364.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20364.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":33760.42},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20364.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20364.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20364.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20364.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20364.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20364.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20364.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38809.71},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35449.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20364.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":46858.68,"10th_percentile":46858.68,"90th_percentile":46858.68,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":92811.22,"10th_percentile":92811.22,"90th_percentile":92811.22,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":84990.52,"10th_percentile":44117.89,"90th_percentile":147982.85,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17254.81,"10th_percentile":17254.81,"90th_percentile":17254.81,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures With Cc Or Spinal Neurostimulators","code_information":[{"code":"029","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":31356.01,"maximum":58540.72,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44466.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31356.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31356.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43285.69},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":44633.23},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":46850.4},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31356.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31356.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":50924.35},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31356.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31356.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31356.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31356.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31356.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31356.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31356.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58540.72},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":53472.4},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31356.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":10531.47,"10th_percentile":10531.47,"90th_percentile":10531.47,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":52862.72,"10th_percentile":51714.37,"90th_percentile":174565.61,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25555.45,"10th_percentile":25555.45,"90th_percentile":25555.45,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":45068.84,"10th_percentile":45068.84,"90th_percentile":45068.84,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":285.37,"10th_percentile":285.37,"90th_percentile":285.37,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures With Mcc","code_information":[{"code":"028","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":54820.91,"maximum":106025.58,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":80535.92},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54820.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54820.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":78396.56},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":80837.14},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":84852.75},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54820.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54820.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":92231.25},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54820.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54820.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54820.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54820.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54820.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54820.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54820.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":106025.58},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":96846.14},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54820.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":46433.13,"10th_percentile":46433.13,"90th_percentile":46433.13,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19082.57,"10th_percentile":19082.57,"90th_percentile":19655.82,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":95919.2,"10th_percentile":95919.2,"90th_percentile":95919.2,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":99178.69,"10th_percentile":93305.45,"90th_percentile":180605.4,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":89967.39,"10th_percentile":89967.39,"90th_percentile":89967.39},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":13160.16,"10th_percentile":13160.16,"90th_percentile":23748.42,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18786.47,"10th_percentile":18786.47,"90th_percentile":19578.2,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":34895.08,"10th_percentile":34895.08,"90th_percentile":34895.08,"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":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"1 through 10","median_amount":37182.04,"10th_percentile":37182.04,"90th_percentile":37182.04,"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":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":34505.56,"10th_percentile":34505.56,"90th_percentile":34505.56,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy And Endovascular Intracranial Procedures With Cc","code_information":[{"code":"026","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28623.4,"maximum":53341.55,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40517.68},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28623.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28623.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39441.37},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":40669.23},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":42689.48},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28623.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28623.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":46401.62},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28623.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28623.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28623.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28623.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28623.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28623.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28623.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53341.55},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":48723.37},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28623.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":87973.77,"10th_percentile":87973.77,"90th_percentile":87973.77,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":16866.91,"10th_percentile":16866.91,"90th_percentile":16866.91,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":59280.05,"10th_percentile":59280.05,"90th_percentile":59280.05,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":27394.21,"10th_percentile":27394.21,"90th_percentile":27394.21},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":72031.38,"10th_percentile":72031.38,"90th_percentile":72031.38,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":16917.93,"10th_percentile":16917.93,"90th_percentile":16917.93,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22962.72,"10th_percentile":22962.72,"90th_percentile":23554.62,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":15202.95,"10th_percentile":15202.95,"90th_percentile":15202.95,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":36807.61,"10th_percentile":36807.61,"90th_percentile":36807.61,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":42619.0,"10th_percentile":42619.0,"90th_percentile":42619.0,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy And Endovascular Intracranial Procedures With Mcc","code_information":[{"code":"025","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":41613.27,"maximum":77996.15,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59245.06},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41613.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41613.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":57671.27},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":59466.64},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":62420.67},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41613.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41613.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":67848.56},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41613.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41613.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41613.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41613.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41613.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41613.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41613.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":77996.15},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":71243.43},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41613.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":53479.1,"10th_percentile":53479.1,"90th_percentile":60234.68,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":25242.66,"10th_percentile":25242.66,"90th_percentile":25242.66,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":34259.08,"10th_percentile":33218.37,"90th_percentile":37536.25,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":103044.54,"10th_percentile":95828.73,"90th_percentile":195329.36,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":139908.29,"10th_percentile":112507.77,"90th_percentile":160781.16,"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":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":28247.76,"10th_percentile":28247.76,"90th_percentile":30615.86,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"16","median_amount":115419.33,"10th_percentile":72634.9,"90th_percentile":220973.37,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":47959.34,"10th_percentile":33306.27,"90th_percentile":48309.7},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":23111.91,"10th_percentile":23111.91,"90th_percentile":28285.03,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"14","median_amount":34281.67,"10th_percentile":33125.89,"90th_percentile":35619.38,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":35990.62,"10th_percentile":35990.62,"90th_percentile":35990.62,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":25062.84,"10th_percentile":22938.49,"90th_percentile":56823.86,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":78001.38,"10th_percentile":78001.38,"90th_percentile":79298.99,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":33796.58,"10th_percentile":21252.74,"90th_percentile":35658.88,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without Mcc","code_information":[{"code":"024","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":35876.94,"maximum":66300.22,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50360.95},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35876.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35876.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":49023.16},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":50549.31},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":53060.36},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35876.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35876.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":57674.31},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35876.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35876.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35876.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35876.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35876.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35876.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35876.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66300.22},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":60560.1},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35876.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30767.43,"10th_percentile":30767.43,"90th_percentile":30767.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27549.22,"10th_percentile":27549.22,"90th_percentile":27549.22,"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":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":103838.69,"10th_percentile":103838.69,"90th_percentile":103838.69,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":78947.8,"10th_percentile":78947.8,"90th_percentile":339176.6,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":39556.24,"10th_percentile":39556.24,"90th_percentile":39556.24},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30718.43,"10th_percentile":30718.43,"90th_percentile":30718.43,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":29207.51,"10th_percentile":29207.51,"90th_percentile":29207.51,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With Mcc Or Antineopla","code_information":[{"code":"023","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":52308.78,"maximum":99495.67,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":75575.87},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52308.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52308.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":73568.27},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":75858.53},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":79626.83},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52308.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52308.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":86550.91},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52308.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52308.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52308.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52308.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52308.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52308.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52308.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":99495.67},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":90881.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52308.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":47952.74,"10th_percentile":47952.74,"90th_percentile":47952.74,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":42699.31,"10th_percentile":42699.31,"90th_percentile":42699.31,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":41973.03,"10th_percentile":41973.03,"90th_percentile":41973.03,"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":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":129833.33,"10th_percentile":129833.33,"90th_percentile":598272.38,"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":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":42324.07,"10th_percentile":42324.07,"90th_percentile":42324.07,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":284125.24,"10th_percentile":174059.06,"90th_percentile":299666.26,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":45220.46,"10th_percentile":45220.46,"90th_percentile":45220.46,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":29532.92,"10th_percentile":29532.92,"90th_percentile":29532.92,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":42498.78,"10th_percentile":41313.88,"90th_percentile":44184.01,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":44679.29,"10th_percentile":44679.29,"90th_percentile":44679.29,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":57728.01,"10th_percentile":57728.01,"90th_percentile":57728.01,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":42934.51,"10th_percentile":42934.51,"90th_percentile":43597.21,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/Mcc","code_information":[{"code":"022","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29239.68,"maximum":61573.71,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46770.74},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29239.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29239.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":45528.32},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":46945.67},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":49277.71},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29239.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29239.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":53562.73},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29239.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29239.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29239.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29239.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29239.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29239.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29239.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61573.71},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":56242.8},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29239.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26334.31,"10th_percentile":26334.31,"90th_percentile":26334.31,"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":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":226229.74,"10th_percentile":226229.74,"90th_percentile":270224.35,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"1 through 10","median_amount":56242.8,"10th_percentile":56242.8,"90th_percentile":56242.8,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27171.28,"10th_percentile":27171.28,"90th_percentile":27171.28,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc","code_information":[{"code":"021","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":48364.38,"maximum":96401.64,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":73225.67},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48364.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48364.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":71280.5},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":73499.55},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":77150.66},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48364.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48364.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":83859.42},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48364.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48364.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48364.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48364.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48364.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48364.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48364.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":96401.64},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":88055.42},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48364.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":239045.81,"10th_percentile":239045.81,"90th_percentile":239045.81,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":232620.82,"10th_percentile":232620.82,"90th_percentile":232620.82,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":93111.42,"10th_percentile":93111.42,"90th_percentile":93111.42,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":42060.81,"10th_percentile":42060.81,"90th_percentile":42060.81,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc","code_information":[{"code":"020","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":71633.19,"maximum":140583.18,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":106785.5},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":71633.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":71633.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":103948.85},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":107184.9},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":112509.35},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":71633.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":71633.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":122292.78},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":71633.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":71633.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":71633.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":71633.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":71633.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":71633.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":71633.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":140583.18},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":128411.83},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":71633.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":489859.63,"10th_percentile":489859.63,"90th_percentile":489859.63,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":93997.68,"10th_percentile":93997.68,"90th_percentile":93997.68,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":16751.91,"10th_percentile":16751.91,"90th_percentile":16751.91,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":111297.47,"10th_percentile":111297.47,"90th_percentile":111297.47,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":61620.07,"10th_percentile":61620.07,"90th_percentile":104321.66,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":60494.33,"10th_percentile":60494.33,"90th_percentile":60494.33,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":74996.55,"10th_percentile":74996.55,"90th_percentile":74996.55,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simultaneous Pancreas And Kidney Transplant With Hemodialysis","code_information":[{"code":"019","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":64998.64,"maximum":138249.57,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":105012.92},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64998.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64998.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":102223.36},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":105405.69},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":110641.75},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64998.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64998.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":120262.78},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64998.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64998.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64998.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64998.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64998.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64998.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64998.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":138249.57},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":126280.26},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64998.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":2430696.92,"10th_percentile":2430696.92,"90th_percentile":2430696.92,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":1186240.57,"10th_percentile":1186240.57,"90th_percentile":1186240.57,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Autologous Bone Marrow Transplant Without Cc/Mcc","code_information":[{"code":"017","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":49615.93,"maximum":105265.16,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":79958.3},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49615.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49615.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":77834.29},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":80257.36},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":84244.17},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49615.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49615.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":91569.76},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49615.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49615.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49615.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49615.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49615.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49615.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49615.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":105265.16},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":96151.55},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49615.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Autologous Bone Marrow Transplant With Cc/Mcc","code_information":[{"code":"016","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":54110.65,"maximum":105265.16,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":79958.3},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54110.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54110.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":77834.29},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":80257.36},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":84244.17},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54110.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54110.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":91569.76},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54110.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54110.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54110.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54110.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54110.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54110.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54110.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":105265.16},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":96151.55},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54110.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":218568.44,"10th_percentile":218568.44,"90th_percentile":218568.44,"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":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":110075.94,"10th_percentile":92443.35,"90th_percentile":439481.85,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":61757.34,"10th_percentile":61757.34,"90th_percentile":61757.34,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":108069.04,"10th_percentile":108069.04,"90th_percentile":108069.04,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Allogeneic Bone Marrow Transplant","code_information":[{"code":"014","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":109126.24,"maximum":228492.8,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":173560.72},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109126.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109126.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":168950.25},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":174209.87},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":182863.8},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109126.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109126.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":198765.02},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109126.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109126.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109126.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109126.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109126.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109126.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109126.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":228492.8},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":208710.44},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109126.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":206345.84,"10th_percentile":206345.84,"90th_percentile":206345.84,"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":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":200599.22,"10th_percentile":200599.22,"90th_percentile":200599.22,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc","code_information":[{"code":"012","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":38624.92,"maximum":71567.4,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54361.84},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38624.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38624.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":52917.77},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":54565.17},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":57275.71},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38624.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38624.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":62256.21},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38624.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38624.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38624.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38624.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38624.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38624.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38624.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":71567.4},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":65371.27},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38624.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":174852.75,"10th_percentile":174852.75,"90th_percentile":174852.75,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":14836.64,"10th_percentile":14836.64,"90th_percentile":14836.64,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc","code_information":[{"code":"011","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":49812.92,"maximum":94104.66,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":71480.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49812.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49812.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":69582.09},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":71748.26},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":75312.38},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49812.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49812.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":81861.29},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49812.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49812.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49812.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49812.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49812.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49812.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49812.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":94104.66},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":85957.3},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49812.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":40131.99,"10th_percentile":40131.99,"90th_percentile":40131.99,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":38075.64,"10th_percentile":38075.64,"90th_percentile":38075.64,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":39432.3,"10th_percentile":39432.3,"90th_percentile":39432.3,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pancreas Transplant","code_information":[{"code":"010","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":65370.04,"maximum":139050.12,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":105621.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65370.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65370.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":102815.29},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":106016.05},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":111282.43},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65370.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65370.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":120959.17},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65370.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65370.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65370.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65370.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65370.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65370.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65370.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":139050.12},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":127011.49},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65370.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simultaneous Pancreas And Kidney Transplant","code_information":[{"code":"008","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":51172.9,"maximum":94892.99,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":72079.72},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51172.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51172.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":70164.99},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":72349.31},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":75943.28},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51172.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51172.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":82547.06},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51172.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51172.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51172.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51172.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51172.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51172.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51172.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":94892.99},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":86677.38},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51172.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lung Transplant","code_information":[{"code":"007","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":117550.9,"maximum":227917.24,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":173123.54},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":117550.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":117550.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":168524.68},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":173771.05},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":182403.19},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":117550.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":117550.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":198264.35},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":117550.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":117550.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":117550.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":117550.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":117550.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":117550.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":117550.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":227917.24},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":208184.71},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":117550.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Liver Transplant Without Mcc","code_information":[{"code":"006","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":42429.26,"maximum":84569.66,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64238.23},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42429.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42429.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":62531.8},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":64478.49},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":67681.48},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42429.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42429.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":73566.83},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42429.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42429.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42429.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42429.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42429.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42429.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42429.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":84569.66},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":77247.83},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42429.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Liver Transplant With Mcc Or Intestinal Transplant","code_information":[{"code":"005","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":93697.44,"maximum":185722.23,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":141072.65},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":93697.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":93697.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":137325.2},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":141600.29},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":148634.33},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":93697.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":93697.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":161559.07},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":93697.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":93697.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":93697.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":93697.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":93697.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":93697.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":93697.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":185722.23},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":169642.85},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":93697.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20926.0,"10th_percentile":20926.0,"90th_percentile":20926.0,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":452202.21,"10th_percentile":452202.21,"90th_percentile":452202.21,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":34101.1,"10th_percentile":34101.1,"90th_percentile":34101.1,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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 Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":152341.09,"10th_percentile":152341.09,"90th_percentile":152341.09,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":445176.03,"10th_percentile":445176.03,"90th_percentile":445176.03,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":495190.1,"10th_percentile":284475.95,"90th_percentile":1212705.94,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":42843.08,"10th_percentile":42843.08,"90th_percentile":42843.08},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":152125.68,"10th_percentile":152125.68,"90th_percentile":152125.68,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Transplant Or Implant Of Heart Assist System With Mcc","code_information":[{"code":"001","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":253763.34,"maximum":491250.18,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":373148.47},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":253763.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":253763.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":363236.15},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":374544.11},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":393149.71},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":253763.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":253763.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":427336.68},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":253763.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":253763.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":253763.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":253763.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":253763.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":253763.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":253763.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":491250.18},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":448718.92},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":253763.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":446933.23,"10th_percentile":446933.23,"90th_percentile":446933.23,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":133545.77,"10th_percentile":133545.77,"90th_percentile":133545.77,"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":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":290314.03,"10th_percentile":290314.03,"90th_percentile":290314.03,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":591071.29,"10th_percentile":591071.29,"90th_percentile":591071.29,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":529231.63,"10th_percentile":529231.63,"90th_percentile":529231.63,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":209607.32,"10th_percentile":209607.32,"90th_percentile":209607.32,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":145399.57,"10th_percentile":145399.57,"90th_percentile":145399.57,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":6391.97,"maximum":11099.45,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8431.03},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6391.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6391.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8207.07},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":8462.56},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8882.94},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6391.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6391.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":9655.37},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6391.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6391.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6391.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6391.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6391.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6391.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6391.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11099.45},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10138.49},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6391.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7827.72,"10th_percentile":7827.72,"90th_percentile":7827.72,"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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":20051.12,"10th_percentile":20051.12,"90th_percentile":20051.12,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30551.13,"10th_percentile":24953.16,"90th_percentile":54306.06,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":5313.68,"10th_percentile":5313.68,"90th_percentile":5313.68,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5203.26,"10th_percentile":5203.26,"90th_percentile":5203.26,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":37216.88,"10th_percentile":17928.13,"90th_percentile":51484.19,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":11205.84,"10th_percentile":11205.84,"90th_percentile":11205.84},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5018.43,"10th_percentile":5018.43,"90th_percentile":5018.43,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":4156.0,"10th_percentile":4156.0,"90th_percentile":4156.0,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5225.27,"10th_percentile":5225.27,"90th_percentile":5225.27,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":22168.68,"maximum":43211.82,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32823.24},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22168.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22168.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31951.33},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":32946.01},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34582.61},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22168.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22168.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":37589.8},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22168.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22168.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22168.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22168.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22168.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22168.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22168.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43211.82},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39470.65},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22168.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19155.23,"10th_percentile":19155.23,"90th_percentile":19155.23,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":14204.87,"maximum":26393.47,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20048.2},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14204.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14204.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19515.64},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":20123.18},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21122.81},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14204.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14204.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":22959.58},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14204.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14204.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14204.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14204.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14204.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14204.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14204.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26393.47},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24108.38},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14204.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":9211.65,"10th_percentile":9211.65,"90th_percentile":9211.65,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11874.76,"10th_percentile":11576.19,"90th_percentile":12217.29,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":98303.33,"10th_percentile":98303.33,"90th_percentile":98303.33,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":46770.04,"10th_percentile":46770.04,"90th_percentile":68788.29,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":9154.63,"10th_percentile":9154.63,"90th_percentile":9154.63,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":65133.14,"10th_percentile":48459.8,"90th_percentile":96950.0,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":13793.43,"10th_percentile":13793.43,"90th_percentile":13793.43},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10507.05,"10th_percentile":10507.05,"90th_percentile":10507.05,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":8325.21,"10th_percentile":8325.21,"90th_percentile":8325.21,"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":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":21280.87,"10th_percentile":21280.87,"90th_percentile":21280.87,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":10871.33,"maximum":19605.43,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14892.08},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10871.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10871.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14496.48},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":14947.78},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15690.31},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10871.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10871.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":17054.69},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10871.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10871.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10871.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10871.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10871.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10871.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10871.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19605.43},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17908.04},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10871.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8903.31,"10th_percentile":8903.31,"90th_percentile":8903.31,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":47597.06,"10th_percentile":47597.06,"90th_percentile":47597.06,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":41423.58,"10th_percentile":40360.48,"90th_percentile":45012.66,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9060.38,"10th_percentile":9060.38,"90th_percentile":9060.38,"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":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":50797.93,"10th_percentile":40652.39,"90th_percentile":74040.43,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":5282.62,"10th_percentile":5282.62,"90th_percentile":5282.62,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8914.61,"10th_percentile":8914.61,"90th_percentile":8914.61,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":7345.38,"10th_percentile":7345.38,"90th_percentile":8027.43,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":19964.71,"10th_percentile":19964.71,"90th_percentile":19964.71,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"1 through 10","median_amount":14322.61,"10th_percentile":14322.61,"90th_percentile":14322.61,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8504.66,"10th_percentile":8504.66,"90th_percentile":8504.66,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":36858.3,"maximum":68529.18,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52054.04},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36858.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36858.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":50671.28},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":52248.73},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":54844.21},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36858.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36858.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":59613.27},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36858.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36858.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36858.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36858.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36858.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36858.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36858.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":68529.18},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":62596.09},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36858.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":47481.49,"10th_percentile":47481.49,"90th_percentile":50841.23,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"14","median_amount":30043.43,"10th_percentile":30016.45,"90th_percentile":31577.86,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":110160.41,"10th_percentile":97093.7,"90th_percentile":181030.68,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":109052.13,"10th_percentile":90574.12,"90th_percentile":131506.14,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":22438.76,"10th_percentile":1972.89,"90th_percentile":22438.76,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30043.43,"10th_percentile":30041.08,"90th_percentile":30055.43,"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":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":29116.0,"10th_percentile":29116.0,"90th_percentile":29116.0,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"19","median_amount":95954.96,"10th_percentile":84600.51,"90th_percentile":123493.97,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":37572.82,"10th_percentile":35876.43,"90th_percentile":46082.36},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17073.48,"10th_percentile":17073.48,"90th_percentile":17073.48,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":29634.29,"10th_percentile":29518.66,"90th_percentile":30055.13,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":18888.4,"10th_percentile":18888.4,"90th_percentile":18888.4,"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":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":68232.68,"10th_percentile":65138.13,"90th_percentile":68847.0,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"1 through 10","median_amount":64050.59,"10th_percentile":64050.59,"90th_percentile":64050.59,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30059.23,"10th_percentile":30035.5,"90th_percentile":31571.87,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pancreas, Liver And Shunt Procedures With Mcc","code_information":[{"code":"405","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":49961.12,"maximum":94676.72,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":71915.44},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49961.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49961.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":70005.08},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":72184.42},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":75770.2},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49961.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49961.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":82358.92},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49961.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49961.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49961.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49961.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49961.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49961.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49961.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":94676.72},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":86479.84},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49961.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":71919.42,"10th_percentile":71919.42,"90th_percentile":71919.42,"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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":41528.23,"10th_percentile":41528.23,"90th_percentile":41528.23,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6206.83,"10th_percentile":6206.83,"90th_percentile":6206.83,"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":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":88889.06,"10th_percentile":88889.06,"90th_percentile":123897.02,"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":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":80701.2,"10th_percentile":80701.2,"90th_percentile":80701.2,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":131691.57,"10th_percentile":131691.57,"90th_percentile":131691.57,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":18556.72,"10th_percentile":18556.72,"90th_percentile":18556.72,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":41530.85,"10th_percentile":41530.85,"90th_percentile":41530.85,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"1 through 10","median_amount":51147.56,"10th_percentile":51147.56,"90th_percentile":51147.56,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":104708.26,"10th_percentile":104708.26,"90th_percentile":104708.26,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21005.86,"10th_percentile":21005.86,"90th_percentile":21005.86,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":113838.2,"10th_percentile":113838.2,"90th_percentile":113838.2,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"1 through 10","median_amount":31111.95,"10th_percentile":31111.95,"90th_percentile":31111.95,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21680.53,"10th_percentile":21680.53,"90th_percentile":21680.53,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":13159.36,"maximum":23632.56,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17951.04},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13159.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13159.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17474.19},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":18018.18},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18913.24},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13159.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13159.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":20557.87},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13159.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13159.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13159.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13159.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13159.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13159.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13159.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23632.56},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21586.51},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13159.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17952.36,"10th_percentile":17952.36,"90th_percentile":17952.36,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":10533.27,"10th_percentile":10533.27,"90th_percentile":10533.27,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":56378.19,"10th_percentile":56378.19,"90th_percentile":56378.19,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10327.78,"10th_percentile":10327.78,"90th_percentile":10327.78,"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":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":117889.38,"10th_percentile":117889.38,"90th_percentile":117889.38,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":12316.75,"10th_percentile":12316.75,"90th_percentile":12316.75},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"1 through 10","median_amount":21588.1,"10th_percentile":21588.1,"90th_percentile":21588.1,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System 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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":4448.48,"10th_percentile":4448.48,"90th_percentile":4448.48,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17452.45,"10th_percentile":17452.45,"90th_percentile":17452.45,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":51461.58,"10th_percentile":51461.58,"90th_percentile":51461.58,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"1 through 10","median_amount":251811.4,"10th_percentile":251811.4,"90th_percentile":251811.4,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":97774.83,"10th_percentile":73249.7,"90th_percentile":159674.98,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":9471.53,"10th_percentile":9471.53,"90th_percentile":9471.53,"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":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17456.46,"10th_percentile":17456.46,"90th_percentile":17456.46,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System 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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":32705.37,"10th_percentile":32705.37,"90th_percentile":32705.37,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":31081.05,"10th_percentile":31081.05,"90th_percentile":31081.05,"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":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":16835.76,"10th_percentile":16835.76,"90th_percentile":16835.76,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25582.67,"10th_percentile":25582.67,"90th_percentile":25582.67,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":106885.36,"10th_percentile":106885.36,"90th_percentile":252397.23,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":15984.9,"10th_percentile":15984.9,"90th_percentile":15984.9,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":32723.53,"10th_percentile":32723.53,"90th_percentile":32723.53,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":15475.04,"10th_percentile":15475.04,"90th_percentile":15475.04,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","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":"Aetna","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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":57026.47,"10th_percentile":39362.61,"90th_percentile":94649.09,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":21278.44,"10th_percentile":21278.44,"90th_percentile":22808.05},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9328.38,"10th_percentile":9328.38,"90th_percentile":9328.38,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":8521.81,"10th_percentile":8521.81,"90th_percentile":8521.81,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8667.69,"10th_percentile":8667.69,"90th_percentile":8667.69,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hernia Procedures Except Inguinal And Femoral With Cc","code_information":[{"code":"354","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15730.22,"maximum":29668.89,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22536.17},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15730.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15730.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21937.52},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":22620.46},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23744.14},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15730.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15730.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":25808.85},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15730.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15730.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15730.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15730.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15730.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15730.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15730.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29668.89},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27100.22},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15730.22,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13320.75,"10th_percentile":13320.75,"90th_percentile":13320.75,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":86199.29,"10th_percentile":86199.29,"90th_percentile":86199.29,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":136093.79,"10th_percentile":136093.79,"90th_percentile":136093.79,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":47261.7,"10th_percentile":47261.7,"90th_percentile":47261.7},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12885.85,"10th_percentile":12885.85,"90th_percentile":13279.76,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":25168.89,"10th_percentile":25168.89,"90th_percentile":25168.89,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hernia Procedures Except Inguinal And Femoral With Mcc","code_information":[{"code":"353","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26751.05,"maximum":51150.96,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38853.73},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26751.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26751.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37821.62},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":38999.05},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40936.35},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26751.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26751.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":44496.03},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26751.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26751.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26751.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26751.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26751.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26751.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26751.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51150.96},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":46722.44},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26751.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22619.54,"10th_percentile":22619.54,"90th_percentile":22619.54,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal And Femoral Hernia Procedures Without Cc/Mcc","code_information":[{"code":"352","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11080.07,"maximum":19228.7,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14605.92},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11080.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11080.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14217.93},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":14660.55},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15388.82},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11080.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11080.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":16726.98},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11080.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11080.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11080.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11080.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11080.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11080.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11080.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19228.7},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17563.93},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11080.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":67507.72,"10th_percentile":67507.72,"90th_percentile":67507.72,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal And Femoral Hernia Procedures With Cc","code_information":[{"code":"351","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14303.37,"maximum":26243.47,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19934.27},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14303.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14303.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19404.73},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":20008.82},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21002.77},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14303.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14303.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":22829.1},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14303.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14303.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14303.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14303.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14303.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14303.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14303.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26243.47},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23971.38},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14303.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19931.62,"10th_percentile":19931.62,"90th_percentile":19931.62,"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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11992.61,"10th_percentile":11992.61,"90th_percentile":11992.61,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal And Femoral Hernia Procedures With Mcc","code_information":[{"code":"350","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23045.21,"maximum":42203.73,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32057.51},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23045.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23045.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31205.93},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":32177.41},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33775.83},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23045.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23045.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":36712.87},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23045.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23045.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23045.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23045.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23045.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23045.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23045.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42203.73},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38549.83},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23045.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Anal And Stomal Procedures Without Cc/Mcc","code_information":[{"code":"349","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8394.45,"maximum":15363.78,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11670.16},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8394.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8394.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11360.16},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11713.81},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12295.7},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8394.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8394.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":13364.89},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8394.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8394.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8394.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8394.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8394.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8394.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8394.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15363.78},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14033.62},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8394.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":38594.26,"10th_percentile":38594.26,"90th_percentile":38594.26,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":8942.26,"10th_percentile":8942.26,"90th_percentile":8942.26},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Anal And Stomal Procedures With Cc","code_information":[{"code":"348","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12354.21,"maximum":21954.73,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16676.58},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12354.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12354.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16233.59},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":16738.96},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17570.47},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12354.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12354.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":19098.34},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12354.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12354.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12354.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12354.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12354.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12354.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12354.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21954.73},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20053.94},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12354.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15057.35,"10th_percentile":15057.35,"90th_percentile":15057.35,"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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":22828.26,"10th_percentile":22828.26,"90th_percentile":22828.26,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":5624.25,"10th_percentile":5624.25,"90th_percentile":5624.25,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9510.67,"10th_percentile":4748.11,"90th_percentile":9934.3,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Anal And Stomal Procedures With Mcc","code_information":[{"code":"347","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21271.36,"maximum":41275.87,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31352.72},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21271.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21271.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30519.86},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":31469.98},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33033.26},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21271.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21271.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":35905.72},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21271.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21271.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21271.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21271.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21271.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21271.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21271.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41275.87},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37702.3},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21271.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":283.87,"10th_percentile":283.87,"90th_percentile":283.87,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Small And Large Bowel Procedures Without Cc/Mcc","code_information":[{"code":"346","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11246.34,"maximum":21717.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16496.41},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11246.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11246.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16058.2},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":16558.11},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17380.64},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11246.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11246.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":18892.0},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11246.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11246.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11246.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11246.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11246.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11246.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11246.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21717.53},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19837.28},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11246.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15317.19,"10th_percentile":15317.19,"90th_percentile":15317.19,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9831.5,"10th_percentile":9831.5,"90th_percentile":9831.5,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":67723.0,"10th_percentile":67723.0,"90th_percentile":67723.0,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Small And Large Bowel Procedures With Cc","code_information":[{"code":"345","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14124.45,"maximum":25973.14,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19728.92},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14124.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14124.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19204.84},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":19802.71},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20786.42},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14124.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14124.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":22593.93},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14124.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14124.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14124.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14124.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14124.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14124.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14124.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25973.14},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23724.45},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14124.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18311.01,"10th_percentile":18311.01,"90th_percentile":18311.01,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":15190.4,"10th_percentile":15190.4,"90th_percentile":15190.4,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":88526.99,"10th_percentile":88526.99,"90th_percentile":88526.99,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11769.72,"10th_percentile":11769.72,"90th_percentile":11769.72,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":72711.66,"10th_percentile":72711.66,"90th_percentile":72711.66,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":24766.55,"10th_percentile":24766.55,"90th_percentile":24766.55},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11686.48,"10th_percentile":11686.48,"90th_percentile":11686.48,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Small And Large Bowel Procedures With Mcc","code_information":[{"code":"344","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23866.62,"maximum":46993.03,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35695.41},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23866.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23866.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34747.2},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":35828.92},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37608.73},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23866.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23866.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":40879.06},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23866.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23866.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23866.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23866.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23866.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23866.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23866.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46993.03},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":42924.49},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23866.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":521451.83,"10th_percentile":521451.83,"90th_percentile":521451.83,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20806.76,"10th_percentile":20806.76,"90th_percentile":20806.76,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peritoneal Adhesiolysis Without Cc/Mcc","code_information":[{"code":"337","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14398.25,"maximum":26771.94,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20335.68},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14398.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14398.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19795.48},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":20411.74},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21425.7},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14398.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14398.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":23288.81},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14398.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14398.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14398.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14398.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14398.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14398.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14398.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26771.94},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24454.09},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14398.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20337.0,"10th_percentile":20337.0,"90th_percentile":20337.0,"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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12064.46,"10th_percentile":12064.46,"90th_percentile":12368.63,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":50401.75,"10th_percentile":50401.75,"90th_percentile":50401.75,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":119280.63,"10th_percentile":119280.63,"90th_percentile":119280.63,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9851.01,"10th_percentile":9851.01,"90th_percentile":9851.01,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":50597.54,"10th_percentile":49936.4,"90th_percentile":72094.45,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":26773.68,"10th_percentile":26773.68,"90th_percentile":26773.68,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11089.44,"10th_percentile":11089.44,"90th_percentile":11089.44,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peritoneal Adhesiolysis With Cc","code_information":[{"code":"336","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19582.45,"maximum":36842.37,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27985.08},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19582.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19582.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27241.68},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":28089.74},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29485.11},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19582.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19582.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":32049.04},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19582.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19582.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19582.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19582.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19582.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19582.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19582.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36842.37},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33652.64},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19582.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27463.81,"10th_percentile":27463.81,"90th_percentile":27463.81,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":13792.6,"10th_percentile":13792.6,"90th_percentile":13792.6,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16407.9,"10th_percentile":16407.9,"90th_percentile":16407.9,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":84418.28,"10th_percentile":84418.28,"90th_percentile":84418.28,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":66647.18,"10th_percentile":66647.18,"90th_percentile":66647.18,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":10809.79,"10th_percentile":10809.79,"90th_percentile":10809.79,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16397.32,"10th_percentile":16397.32,"90th_percentile":16397.32,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":10786.44,"10th_percentile":10357.52,"90th_percentile":20070.22,"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":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16419.98,"10th_percentile":16389.55,"90th_percentile":16798.9,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peritoneal Adhesiolysis With Mcc","code_information":[{"code":"335","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32795.52,"maximum":63204.44,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48009.43},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32795.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32795.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":46734.1},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":48188.99},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":50582.79},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32795.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32795.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":54981.3},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32795.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32795.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32795.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32795.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32795.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32795.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32795.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":63204.44},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":57732.35},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32795.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":180644.0,"10th_percentile":180644.0,"90th_percentile":180644.0,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":47550.49,"10th_percentile":47550.49,"90th_percentile":47550.49,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27851.7,"10th_percentile":27851.7,"90th_percentile":27851.7,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rectal Resection Without Cc/Mcc","code_information":[{"code":"334","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15328.1,"maximum":28924.15,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21970.48},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15328.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15328.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21386.86},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":22052.66},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23148.13},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15328.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15328.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":25161.01},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15328.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15328.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15328.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15328.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15328.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15328.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15328.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28924.15},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26419.97},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15328.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rectal Resection With Cc","code_information":[{"code":"333","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21692.46,"maximum":37063.87,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28153.32},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21692.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21692.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27405.46},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":28258.62},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29662.38},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21692.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21692.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":32241.72},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21692.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21692.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21692.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21692.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21692.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21692.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21692.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37063.87},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33854.97},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21692.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16495.87,"10th_percentile":16495.87,"90th_percentile":16495.87,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rectal Resection With Mcc","code_information":[{"code":"332","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33245.53,"maximum":60494.11,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45950.69},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33245.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33245.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44730.05},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":46122.55},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":48413.7},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33245.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33245.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":52623.6},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33245.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33245.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33245.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33245.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33245.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33245.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33245.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60494.11},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":55256.67},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33245.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Small And Large Bowel Procedures Without Cc/Mcc","code_information":[{"code":"331","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15734.74,"maximum":28795.09,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21872.45},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15734.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15734.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21291.43},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":21954.26},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23044.84},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15734.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15734.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":25048.74},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15734.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15734.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15734.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15734.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15734.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15734.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15734.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28795.09},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26302.08},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15734.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21872.45,"10th_percentile":19500.12,"90th_percentile":22295.06,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":10657.15,"10th_percentile":10657.15,"90th_percentile":10657.15,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12905.02,"10th_percentile":12898.94,"90th_percentile":12917.93,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":51084.51,"10th_percentile":42813.42,"90th_percentile":85890.24,"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":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"12","median_amount":59333.13,"10th_percentile":36204.99,"90th_percentile":102576.86,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":10149.67,"10th_percentile":10149.67,"90th_percentile":10149.67,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12898.94,"10th_percentile":12898.94,"90th_percentile":12898.94,"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":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"37","median_amount":59497.57,"10th_percentile":35384.29,"90th_percentile":96824.15,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":29145.72,"10th_percentile":18294.93,"90th_percentile":37258.67},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"11","median_amount":12907.73,"10th_percentile":12714.36,"90th_percentile":13513.42,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":9211.18,"10th_percentile":9211.18,"90th_percentile":12463.05,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10640.94,"10th_percentile":10640.94,"90th_percentile":10640.94,"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":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":9063.22,"10th_percentile":9063.22,"90th_percentile":9063.22,"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":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":28795.09,"10th_percentile":26763.76,"90th_percentile":29351.46,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"1 through 10","median_amount":26302.08,"10th_percentile":26302.08,"90th_percentile":26302.08,"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":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12898.56,"10th_percentile":11077.13,"90th_percentile":13150.52,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Small And Large Bowel Procedures With Cc","code_information":[{"code":"330","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22189.46,"maximum":41225.29,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31314.3},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22189.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22189.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30482.46},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":31431.42},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32992.78},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22189.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22189.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":35861.73},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22189.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22189.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22189.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22189.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22189.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22189.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22189.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41225.29},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37656.1},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22189.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":29502.32,"10th_percentile":19861.77,"90th_percentile":31999.29,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":16374.51,"10th_percentile":12064.22,"90th_percentile":20684.32,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"16","median_amount":17258.04,"10th_percentile":12888.52,"90th_percentile":18310.32,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":87835.01,"10th_percentile":35276.47,"90th_percentile":156989.12,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"14","median_amount":63415.92,"10th_percentile":44318.22,"90th_percentile":133311.03,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":11310.66,"10th_percentile":11310.66,"90th_percentile":11310.66,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17912.93,"10th_percentile":17912.93,"90th_percentile":17912.93,"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":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17752.85,"10th_percentile":17752.85,"90th_percentile":17752.85,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"31","median_amount":68858.95,"10th_percentile":37090.83,"90th_percentile":123075.05,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":29559.83,"10th_percentile":23883.27,"90th_percentile":42645.65},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":12408.6,"10th_percentile":12408.6,"90th_percentile":12408.6,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"20","median_amount":17986.26,"10th_percentile":12939.56,"90th_percentile":18626.18,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":12817.55,"10th_percentile":12817.55,"90th_percentile":12817.55,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":11278.28,"10th_percentile":11278.28,"90th_percentile":11278.28,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":41225.29,"10th_percentile":39547.97,"90th_percentile":41225.29,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"1 through 10","median_amount":37656.1,"10th_percentile":34366.9,"90th_percentile":37656.1,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18308.33,"10th_percentile":15577.35,"90th_percentile":19059.25,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Small And Large Bowel Procedures With Mcc","code_information":[{"code":"329","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":42063.28,"maximum":80083.84,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60830.84},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42063.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42063.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":59214.93},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":61058.36},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":64091.45},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42063.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42063.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":69664.63},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42063.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42063.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42063.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42063.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42063.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42063.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42063.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":80083.84},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":73150.37},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42063.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":18041.59,"10th_percentile":18041.59,"90th_percentile":18041.59,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":36006.66,"10th_percentile":36006.66,"90th_percentile":36006.66,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":203059.48,"10th_percentile":203059.48,"90th_percentile":344506.14,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":69925.77,"10th_percentile":69925.77,"90th_percentile":87128.27,"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":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":20565.41,"10th_percentile":20565.41,"90th_percentile":20565.41,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":33432.65,"10th_percentile":33432.65,"90th_percentile":33432.65,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"18","median_amount":99773.9,"10th_percentile":64635.77,"90th_percentile":207539.26,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":35784.32,"10th_percentile":35784.32,"90th_percentile":35784.32},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":35196.65,"10th_percentile":35113.67,"90th_percentile":36006.66,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":78242.93,"10th_percentile":78242.93,"90th_percentile":78242.93,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":35209.68,"10th_percentile":35209.68,"90th_percentile":35212.43,"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":"Youthcare","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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":9838.31,"10th_percentile":9838.31,"90th_percentile":9838.31,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":111355.06,"10th_percentile":111355.06,"90th_percentile":111355.06,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":19150.06,"10th_percentile":19150.06,"90th_percentile":19150.06},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12443.97,"10th_percentile":12443.97,"90th_percentile":12443.97,"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":"Youthcare","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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":13617.23,"10th_percentile":9455.28,"90th_percentile":43218.89,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12477.01,"10th_percentile":12477.01,"90th_percentile":18791.59,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":66353.73,"10th_percentile":66353.73,"90th_percentile":66353.73,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":135446.97,"10th_percentile":135446.97,"90th_percentile":135446.97,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18227.83,"10th_percentile":18227.83,"90th_percentile":18805.5,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":88366.01,"10th_percentile":68492.79,"90th_percentile":148809.6,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":38856.34,"10th_percentile":38856.34,"90th_percentile":38856.34},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18780.22,"10th_percentile":18780.22,"90th_percentile":18780.22,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"1 through 10","median_amount":38682.06,"10th_percentile":38682.06,"90th_percentile":38682.06,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17174.2,"10th_percentile":17174.2,"90th_percentile":17174.2,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":45595.62,"maximum":88577.61,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67282.62},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45595.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45595.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":65495.32},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":67534.27},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":70889.05},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45595.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45595.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":77053.33},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45595.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45595.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45595.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45595.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45595.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45595.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45595.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":88577.61},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":80908.77},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45595.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":63436.13,"10th_percentile":63436.13,"90th_percentile":63436.13,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":38896.63,"10th_percentile":38896.63,"90th_percentile":38896.63,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":37722.93,"10th_percentile":37722.93,"90th_percentile":37722.93,"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":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":92778.96,"10th_percentile":92778.96,"90th_percentile":150859.92,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":81653.86,"10th_percentile":38889.62,"90th_percentile":87848.33,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":33971.28,"10th_percentile":33971.28,"90th_percentile":33971.28,"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":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":39021.76,"10th_percentile":39021.76,"90th_percentile":39021.76,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pancreas, Liver And Shunt Procedures Without Cc/Mcc","code_information":[{"code":"407","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20584.59,"maximum":37247.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28292.43},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20584.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20584.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27540.87},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":28398.25},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29808.94},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20584.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20584.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":32401.02},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20584.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20584.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20584.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20584.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20584.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20584.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20584.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37247.0},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34022.24},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20584.59,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":84851.16,"10th_percentile":84851.16,"90th_percentile":84851.16,"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":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":131287.16,"10th_percentile":131287.16,"90th_percentile":131287.16,"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":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":111224.38,"10th_percentile":111224.38,"90th_percentile":111224.38,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":34733.65,"10th_percentile":34733.65,"90th_percentile":34733.65},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16567.63,"10th_percentile":16567.63,"90th_percentile":16567.63,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":36778.48,"10th_percentile":36778.48,"90th_percentile":36778.48,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Mcc","code_information":[{"code":"408","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32747.62,"maximum":61062.69,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46382.57},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32747.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32747.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":45150.47},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":46556.05},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":48868.74},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32747.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32747.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":53118.2},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32747.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32747.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32747.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32747.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32747.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32747.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32747.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61062.69},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":55776.02},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32747.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6218.39,"10th_percentile":6218.39,"90th_percentile":6218.39,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":28698.49,"10th_percentile":28698.49,"90th_percentile":28698.49,"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":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26940.27,"10th_percentile":26940.27,"90th_percentile":26940.27,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc","code_information":[{"code":"409","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20202.35,"maximum":36561.57,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27771.78},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20202.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20202.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27034.05},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":27875.65},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29260.39},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20202.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20202.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":31804.77},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20202.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20202.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20202.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20202.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20202.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20202.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20202.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36561.57},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33396.16},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20202.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":135477.12,"10th_percentile":135477.12,"90th_percentile":135477.12,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27208.17,"10th_percentile":27208.17,"90th_percentile":27208.17,"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":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14589.04,"10th_percentile":14589.04,"90th_percentile":14589.04,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16488.26,"10th_percentile":16488.26,"90th_percentile":16488.26,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17335.74,"10th_percentile":17335.74,"90th_percentile":17335.74,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16286.09,"10th_percentile":16286.09,"90th_percentile":16286.09,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/Mcc","code_information":[{"code":"410","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14874.47,"maximum":27050.99,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20547.65},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14874.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14874.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20001.82},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":20624.5},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21649.03},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14874.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14874.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":23531.55},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14874.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14874.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14874.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14874.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14874.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14874.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14874.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27050.99},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24708.98},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14874.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":8657.13,"10th_percentile":8657.13,"90th_percentile":8657.13,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy With C.D.E. With Mcc","code_information":[{"code":"411","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30377.37,"maximum":47725.55,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36251.83},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30377.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30377.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35288.83},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":36387.42},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38194.97},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30377.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30377.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":41516.28},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30377.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30377.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30377.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30377.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30377.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30377.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30377.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47725.55},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43593.59},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30377.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":111362.32,"10th_percentile":111362.32,"90th_percentile":111362.32,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy With C.D.E. With Cc","code_information":[{"code":"412","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19526.42,"maximum":37175.49,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28238.11},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19526.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19526.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27487.99},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":28343.73},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29751.71},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19526.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19526.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":32338.82},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19526.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19526.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19526.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19526.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19526.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19526.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19526.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37175.49},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33956.93},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19526.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":78156.15,"10th_percentile":78156.15,"90th_percentile":78156.15,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy With C.D.E. Without Cc/Mcc","code_information":[{"code":"413","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15532.32,"maximum":28993.92,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22023.48},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15532.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15532.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21438.44},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":22105.85},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23203.96},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15532.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15532.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":25221.7},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15532.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15532.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15532.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15532.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15532.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15532.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15532.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28993.92},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26483.69},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15532.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy Except By Laparoscope Without C.D.E. With Mcc","code_information":[{"code":"414","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32720.52,"maximum":61106.29,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46415.69},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32720.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32720.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":45182.71},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":46589.3},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":48903.63},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32720.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32720.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":53156.13},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32720.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32720.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32720.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32720.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32720.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32720.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32720.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61106.29},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":55815.85},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32720.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy Except By Laparoscope Without C.D.E. With Cc","code_information":[{"code":"415","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19202.92,"maximum":34498.3,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26204.54},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19202.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19202.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25508.45},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":26302.55},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27609.14},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19202.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19202.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":30009.94},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19202.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19202.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19202.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19202.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19202.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19202.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19202.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34498.3},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31511.52},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19202.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/Mcc","code_information":[{"code":"416","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12846.69,"maximum":23897.66,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18152.41},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12846.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12846.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17670.21},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":18220.3},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19125.4},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12846.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12846.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":20788.48},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12846.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12846.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12846.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12846.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12846.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12846.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12846.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23897.66},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21828.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12846.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Laparoscopic Cholecystectomy Without C.D.E. 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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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16783.96,"10th_percentile":12944.59,"90th_percentile":18414.39,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":175544.99,"10th_percentile":175544.99,"90th_percentile":175544.99,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":74034.28,"10th_percentile":74034.28,"90th_percentile":94626.76,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"11","median_amount":70141.11,"10th_percentile":51241.87,"90th_percentile":89821.68,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":26196.0,"10th_percentile":26196.0,"90th_percentile":26196.0},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18427.19,"10th_percentile":18427.19,"90th_percentile":18427.19,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Laparoscopic Cholecystectomy Without C.D.E. 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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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":74378.2,"10th_percentile":68096.54,"90th_percentile":84048.61,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"13","median_amount":64612.01,"10th_percentile":46184.1,"90th_percentile":80437.57,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14708.25,"10th_percentile":14708.25,"90th_percentile":14708.25,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"13","median_amount":67681.9,"10th_percentile":59747.38,"90th_percentile":92406.68,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":17108.59,"10th_percentile":17072.11,"90th_percentile":28210.27},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":8657.13,"10th_percentile":8657.13,"90th_percentile":9517.1,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12849.59,"10th_percentile":12849.59,"90th_percentile":12849.59,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":9396.26,"10th_percentile":9396.26,"90th_percentile":12850.21,"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":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":24094.07,"10th_percentile":24094.07,"90th_percentile":26358.55,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11133.22,"10th_percentile":11133.22,"90th_percentile":12964.1,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc","code_information":[{"code":"419","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12869.29,"maximum":22980.26,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17455.56},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12869.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12869.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16991.88},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":17520.85},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18391.21},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12869.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12869.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":19990.44},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12869.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12869.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12869.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12869.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12869.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12869.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12869.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22980.26},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20990.69},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12869.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17455.56,"10th_percentile":17292.07,"90th_percentile":18094.12,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10029.22,"10th_percentile":10029.22,"90th_percentile":10029.22,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":84061.65,"10th_percentile":84061.65,"90th_percentile":84061.65,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":71928.5,"10th_percentile":51914.3,"90th_percentile":95849.96,"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":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":7207.35,"10th_percentile":7207.35,"90th_percentile":8467.26,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"20","median_amount":67864.77,"10th_percentile":43195.89,"90th_percentile":87917.72,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":19145.89,"10th_percentile":19145.89,"90th_percentile":22155.45},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":8657.13,"10th_percentile":8657.13,"90th_percentile":8657.13,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10397.72,"10th_percentile":10397.72,"90th_percentile":10397.72,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":7588.45,"10th_percentile":7588.45,"90th_percentile":10275.07,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":23820.92,"10th_percentile":23820.92,"90th_percentile":23820.92,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5960.22,"10th_percentile":5960.22,"90th_percentile":5960.22,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hepatobiliary Diagnostic Procedures With Mcc","code_information":[{"code":"420","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":31315.35,"maximum":61552.78,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46754.84},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31315.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31315.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":45512.85},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":46929.71},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":49260.96},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31315.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31315.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":53544.53},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31315.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31315.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31315.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31315.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31315.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31315.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31315.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61552.78},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":56223.69},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31315.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27416.94,"10th_percentile":27416.94,"90th_percentile":27416.94,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":61558.01,"10th_percentile":61558.01,"90th_percentile":61558.01,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hepatobiliary Diagnostic Procedures With Cc","code_information":[{"code":"421","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16228.13,"maximum":28559.64,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21693.6},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16228.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16228.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21117.33},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":21774.74},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22856.41},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16228.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16228.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":24843.92},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16228.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16228.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16228.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16228.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16228.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16228.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16228.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28559.64},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26087.01},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16228.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12012.84,"10th_percentile":12012.84,"90th_percentile":12012.84,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hepatobiliary Diagnostic Procedures Without Cc/Mcc","code_information":[{"code":"422","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13173.81,"maximum":25626.06,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19465.29},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13173.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13173.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18948.21},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":19538.09},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20508.65},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13173.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13173.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":22292.01},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13173.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13173.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13173.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13173.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13173.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13173.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13173.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25626.06},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23407.42},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13173.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11321.57,"10th_percentile":11321.57,"90th_percentile":11321.57,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Hepatobiliary Or Pancreas O.R. Procedures With Mcc","code_information":[{"code":"423","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":38055.62,"maximum":70934.29,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53880.94},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38055.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38055.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":52449.65},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":54082.47},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":56769.03},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38055.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38055.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":61705.47},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38055.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38055.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38055.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38055.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38055.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38055.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38055.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":70934.29},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":64792.97},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38055.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":109308.11,"10th_percentile":109308.11,"90th_percentile":109308.11,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":31220.1,"10th_percentile":31220.1,"90th_percentile":31220.1,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Hepatobiliary Or Pancreas O.R. Procedures With Cc","code_information":[{"code":"424","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20298.13,"maximum":39819.55,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30246.51},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20298.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20298.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29443.04},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":30359.64},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31867.76},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20298.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20298.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":34638.87},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20298.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20298.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20298.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20298.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20298.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20298.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20298.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39819.55},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36372.07},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20298.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":191972.82,"10th_percentile":191972.82,"90th_percentile":191972.82,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/Mcc","code_information":[{"code":"425","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14084.69,"maximum":26958.55,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20477.43},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14084.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14084.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19933.47},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":20554.02},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21575.05},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14084.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14084.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":23451.14},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14084.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14084.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14084.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14084.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14084.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14084.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14084.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26958.55},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24624.55},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14084.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19741.46,"10th_percentile":19741.46,"90th_percentile":19741.46,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11756.78,"10th_percentile":11756.78,"90th_percentile":11756.78,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","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":"1 through 10","median_amount":50807.63,"10th_percentile":50807.63,"90th_percentile":50807.63,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","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":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":83861.14,"10th_percentile":83861.14,"90th_percentile":83861.14,"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":"Youthcare","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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":54195.59,"10th_percentile":43921.16,"90th_percentile":63981.15,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":438886.03,"10th_percentile":438886.03,"90th_percentile":438886.03,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":149683.6,"10th_percentile":149683.6,"90th_percentile":149683.6,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":31084.22,"10th_percentile":31084.22,"90th_percentile":31084.22,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":54205.82,"10th_percentile":54205.82,"90th_percentile":54238.53,"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":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"12","median_amount":154445.13,"10th_percentile":108004.41,"90th_percentile":201664.8,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":36756.02,"10th_percentile":36756.02,"90th_percentile":36756.02},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":54228.27,"10th_percentile":42255.16,"90th_percentile":54251.67,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":43383.77,"10th_percentile":43383.77,"90th_percentile":43383.77,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":1114.95,"10th_percentile":1114.95,"90th_percentile":1114.95,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":122360.65,"10th_percentile":122360.65,"90th_percentile":122360.65,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":54042.78,"10th_percentile":54042.78,"90th_percentile":55473.44,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":51330.14,"maximum":96016.19,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":72932.89},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51330.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51330.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":70995.5},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":73205.67},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":76842.19},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51330.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51330.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":83524.12},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51330.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51330.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51330.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51330.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51330.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51330.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51330.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":96016.19},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":87703.34},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51330.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":72918.32,"10th_percentile":72918.32,"90th_percentile":72918.32,"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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":43921.16,"10th_percentile":43921.16,"90th_percentile":43921.16,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":115868.8,"10th_percentile":115868.8,"90th_percentile":115868.8,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":183311.47,"10th_percentile":183311.47,"90th_percentile":183311.47,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":18888.4,"10th_percentile":18888.4,"90th_percentile":18888.4,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":127603.18,"10th_percentile":116269.4,"90th_percentile":136691.23,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":47743.48,"10th_percentile":47743.48,"90th_percentile":47743.48,"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":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":33801.47,"10th_percentile":33801.47,"90th_percentile":33801.47,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":42112.59,"10th_percentile":42112.59,"90th_percentile":42136.0,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":40912.64,"10th_percentile":40912.64,"90th_percentile":40912.64,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":17141.89,"10th_percentile":17141.89,"90th_percentile":17141.89,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":91643.27,"10th_percentile":91154.16,"90th_percentile":98391.2,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"1 through 10","median_amount":87575.26,"10th_percentile":87575.26,"90th_percentile":87575.26,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":42114.85,"10th_percentile":42112.59,"90th_percentile":43921.16,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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":81941.95,"maximum":145457.94,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":110488.32},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":81941.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":81941.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":107553.31},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":110901.57},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":116410.64},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":81941.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":81941.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":126533.31},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":81941.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":81941.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":81941.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":81941.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":81941.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":81941.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":81941.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":145457.94},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":132864.54},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":81941.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc","code_information":[{"code":"430","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":52641.32,"maximum":95404.01,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":72467.88},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52641.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52641.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":70542.85},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":72738.93},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":76352.26},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52641.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52641.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":82991.59},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52641.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52641.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52641.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52641.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52641.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52641.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52641.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":95404.01},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":87144.16},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52641.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":78572.93,"10th_percentile":78572.93,"90th_percentile":78572.93,"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":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":185055.63,"10th_percentile":185055.63,"90th_percentile":243863.59,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":45041.41,"10th_percentile":45041.41,"90th_percentile":45041.41,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cirrhosis And Alcoholic Hepatitis With Mcc","code_information":[{"code":"432","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18312.83,"maximum":34168.66,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25954.16},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18312.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18312.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25264.71},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":26051.23},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27345.33},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18312.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18312.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":29723.19},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18312.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18312.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18312.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18312.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18312.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18312.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18312.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34168.66},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31210.42},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18312.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25951.76,"10th_percentile":25951.76,"90th_percentile":25951.76,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":7005.62,"10th_percentile":7005.62,"90th_percentile":7005.62,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15712.16,"10th_percentile":15712.16,"90th_percentile":15712.16,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":46539.18,"10th_percentile":46539.18,"90th_percentile":194737.76,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":38470.46,"10th_percentile":38470.46,"90th_percentile":80503.59,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":7005.62,"10th_percentile":4678.86,"90th_percentile":14020.02,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15240.8,"10th_percentile":15240.8,"90th_percentile":15240.8,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":69744.44,"10th_percentile":45255.1,"90th_percentile":286784.86,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":17707.76,"10th_percentile":17707.76,"90th_percentile":17707.76},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":6782.22,"10th_percentile":6369.83,"90th_percentile":23322.91,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15265.31,"10th_percentile":15265.31,"90th_percentile":15265.31,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15398.26,"10th_percentile":15398.26,"90th_percentile":15398.26,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":7005.62,"10th_percentile":6782.22,"90th_percentile":30140.14,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":14539.63,"10th_percentile":14539.63,"90th_percentile":14539.63,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":33415.73,"10th_percentile":33415.73,"90th_percentile":34168.66,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"1 through 10","median_amount":31210.42,"10th_percentile":31210.42,"90th_percentile":31210.42,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cirrhosis And Alcoholic Hepatitis With Cc","code_information":[{"code":"433","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10071.61,"maximum":18656.64,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14171.39},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10071.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10071.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13794.94},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":14224.39},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14930.99},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10071.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10071.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":16229.34},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10071.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10071.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10071.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10071.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10071.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10071.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10071.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18656.64},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17041.39},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10071.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13992.54,"10th_percentile":13992.54,"90th_percentile":13992.54,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":7005.62,"10th_percentile":7005.62,"90th_percentile":7005.62,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7749.5,"10th_percentile":7749.5,"90th_percentile":7749.5,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":3653.78,"10th_percentile":3653.78,"90th_percentile":3653.78,"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":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":4678.86,"10th_percentile":3616.89,"90th_percentile":13785.08,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8238.68,"10th_percentile":8238.68,"90th_percentile":8238.68,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":25910.8,"10th_percentile":25910.8,"90th_percentile":43772.43,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":10464.88,"10th_percentile":10464.88,"90th_percentile":10464.88},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7928.36,"10th_percentile":7928.36,"90th_percentile":7928.36,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":4258.22,"10th_percentile":4258.22,"90th_percentile":4258.22,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8103.92,"10th_percentile":8103.92,"90th_percentile":8103.92,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8585.66,"10th_percentile":8585.66,"90th_percentile":8585.66,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":4485.33,"10th_percentile":4258.22,"90th_percentile":7005.62,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":6478.07,"10th_percentile":6478.07,"90th_percentile":6478.07,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8513.63,"10th_percentile":8513.63,"90th_percentile":9662.93,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cirrhosis And Alcoholic Hepatitis Without Cc/Mcc","code_information":[{"code":"434","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6965.79,"maximum":12145.91,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9225.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6965.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6965.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8980.83},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":9260.41},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9720.43},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6965.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6965.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10565.68},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6965.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6965.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6965.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6965.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6965.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6965.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6965.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12145.91},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11094.35},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6965.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","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":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14216.09,"10th_percentile":13008.75,"90th_percentile":14696.94,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12566.89,"10th_percentile":12566.89,"90th_percentile":12566.89,"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":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":90454.98,"10th_percentile":90454.98,"90th_percentile":90454.98,"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":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13530.09,"10th_percentile":13530.09,"90th_percentile":14506.21,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":72033.74,"10th_percentile":31398.18,"90th_percentile":75844.14,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":7500.04,"10th_percentile":6559.14,"90th_percentile":9905.18,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14216.08,"10th_percentile":14216.08,"90th_percentile":14216.08,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":10898.6,"10th_percentile":10898.6,"90th_percentile":10898.6,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11884.86,"10th_percentile":11884.86,"90th_percentile":11884.86,"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 Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":32033.88,"10th_percentile":32033.88,"90th_percentile":32033.88,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14239.68,"10th_percentile":13629.98,"90th_percentile":14696.95,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy Of Hepatobiliary System Or Pancreas With Cc","code_information":[{"code":"436","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10748.44,"maximum":19666.47,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14938.44},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10748.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10748.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14541.62},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":14994.32},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15739.16},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10748.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10748.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":17107.79},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10748.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10748.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10748.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10748.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10748.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10748.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10748.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19666.47},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17963.8},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10748.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":93492.27,"10th_percentile":93492.27,"90th_percentile":93492.27,"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":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":41561.07,"10th_percentile":41561.07,"90th_percentile":41561.07,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":46052.7,"10th_percentile":46052.7,"90th_percentile":46052.7,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":5302.06,"10th_percentile":5302.06,"90th_percentile":5302.06,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7700.99,"10th_percentile":7700.99,"90th_percentile":7700.99,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6718.14,"10th_percentile":6718.14,"90th_percentile":6718.14,"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":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8938.5,"10th_percentile":8938.5,"90th_percentile":8938.5,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy Of Hepatobiliary System Or Pancreas Without Cc/Mcc","code_information":[{"code":"437","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8238.12,"maximum":13692.93,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10401.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8238.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8238.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10124.71},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":10439.91},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10958.51},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8238.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8238.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11911.43},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8238.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8238.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8238.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8238.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8238.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8238.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8238.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13692.93},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12507.43},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8238.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":62751.94,"10th_percentile":62751.94,"90th_percentile":62751.94,"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":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":43197.55,"10th_percentile":43197.55,"90th_percentile":64394.96,"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":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":7268.97,"10th_percentile":7268.97,"90th_percentile":7268.97,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5055.4,"10th_percentile":5055.4,"90th_percentile":5055.4,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":7037.26,"10th_percentile":7037.26,"90th_percentile":7037.26,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":6487.86,"10th_percentile":6487.86,"90th_percentile":6487.86,"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":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11173.42,"10th_percentile":11173.42,"90th_percentile":11173.42,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":8128.77,"maximum":15002.75,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11395.93},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8128.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8128.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11093.21},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11438.55},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12006.77},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8128.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8128.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":13050.83},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8128.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8128.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8128.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8128.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8128.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8128.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8128.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15002.75},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13703.85},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8128.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11210.28,"10th_percentile":11210.28,"90th_percentile":11395.93,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":4864.43,"10th_percentile":4864.43,"90th_percentile":5272.05,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5834.44,"10th_percentile":5046.15,"90th_percentile":6916.39,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":29650.29,"10th_percentile":24653.73,"90th_percentile":51924.91,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":29795.41,"10th_percentile":23238.66,"90th_percentile":48191.68,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":7268.97,"10th_percentile":7268.97,"90th_percentile":7268.97,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6928.39,"10th_percentile":6928.39,"90th_percentile":6928.39,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"17","median_amount":26593.89,"10th_percentile":19145.96,"90th_percentile":48560.17,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":4428.32,"10th_percentile":4428.32,"90th_percentile":4864.43,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6789.26,"10th_percentile":6304.16,"90th_percentile":6919.99,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"11","median_amount":4709.67,"10th_percentile":3360.0,"90th_percentile":5743.24,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":14671.37,"10th_percentile":8048.47,"90th_percentile":14752.75,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6129.68,"10th_percentile":5737.17,"90th_percentile":15002.75,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Pancreas Except Malignancy Without Cc/Mcc","code_information":[{"code":"440","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6142.57,"maximum":10727.96,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8148.84},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6142.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6142.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7932.38},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":8179.32},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8585.63},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6142.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6142.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":9332.21},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6142.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6142.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6142.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6142.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6142.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6142.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6142.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10727.96},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9799.16},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6142.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6809.16,"10th_percentile":6809.16,"90th_percentile":8231.63,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":260.26,"10th_percentile":260.26,"90th_percentile":260.26,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":18769.19,"10th_percentile":18769.19,"90th_percentile":18769.19,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":41474.98,"10th_percentile":23615.26,"90th_percentile":59764.13,"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":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":5743.24,"10th_percentile":3796.4,"90th_percentile":27049.07,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"13","median_amount":24980.07,"10th_percentile":17635.57,"90th_percentile":43628.16,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":4385.15,"10th_percentile":4385.15,"90th_percentile":4385.15},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5318.26,"10th_percentile":5318.26,"90th_percentile":5318.26,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":3796.4,"10th_percentile":3796.4,"90th_percentile":4864.43,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":1235.35,"10th_percentile":1235.35,"90th_percentile":1235.35,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":7862.93,"10th_percentile":7466.24,"90th_percentile":10241.41,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4267.72,"10th_percentile":4267.72,"90th_percentile":4267.72,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc","code_information":[{"code":"441","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16745.01,"maximum":32968.72,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25042.69},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16745.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16745.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24377.46},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":25136.36},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26385.02},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16745.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16745.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":28679.37},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16745.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16745.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16745.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16745.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16745.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16745.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16745.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32968.72},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30114.37},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16745.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14575.09,"10th_percentile":14575.09,"90th_percentile":14575.09,"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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":32636.98,"10th_percentile":32636.98,"90th_percentile":32636.98,"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":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":97311.9,"10th_percentile":97311.9,"90th_percentile":97311.9,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":6986.05,"10th_percentile":4659.29,"90th_percentile":14463.13,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":91833.28,"10th_percentile":55135.99,"90th_percentile":112089.46,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":6431.96,"10th_percentile":6431.96,"90th_percentile":6431.96,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14461.37,"10th_percentile":14461.37,"90th_percentile":14461.37,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14870.46,"10th_percentile":14870.46,"90th_percentile":14870.46,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":11885.84,"10th_percentile":11885.84,"90th_percentile":11885.84,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":21752.86,"10th_percentile":21752.86,"90th_percentile":21752.86,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12549.87,"10th_percentile":12549.87,"90th_percentile":14372.67,"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":"Youthcare","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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":29860.56,"10th_percentile":23993.16,"90th_percentile":44521.89,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":7864.86,"10th_percentile":7864.86,"90th_percentile":7864.86,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7476.8,"10th_percentile":7476.8,"90th_percentile":7476.8,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":24622.41,"10th_percentile":23765.02,"90th_percentile":94878.08,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7708.04,"10th_percentile":6561.44,"90th_percentile":7727.54,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":6502.63,"10th_percentile":6502.63,"90th_percentile":6502.63,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":16851.49,"10th_percentile":16851.49,"90th_percentile":16851.49,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6146.54,"10th_percentile":5885.25,"90th_percentile":7969.34,"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":"Youthcare","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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5919.21,"10th_percentile":5919.21,"90th_percentile":5919.21,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":64582.76,"10th_percentile":64582.76,"90th_percentile":64582.76,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19714.21,"10th_percentile":19714.21,"90th_percentile":19714.21,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5705.44,"10th_percentile":5705.44,"90th_percentile":5705.44,"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":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":29371.17,"10th_percentile":29371.17,"90th_percentile":54537.5,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5024.27,"10th_percentile":5024.27,"90th_percentile":5710.27,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":1263.0,"10th_percentile":1263.0,"90th_percentile":1263.0,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6625.93,"10th_percentile":6625.93,"90th_percentile":6625.93,"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":"Youthcare","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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11985.15,"10th_percentile":11985.15,"90th_percentile":11985.15,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12758.55,"10th_percentile":12758.55,"90th_percentile":12758.55,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":59320.74,"10th_percentile":49232.46,"90th_percentile":79354.86,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":10117.38,"10th_percentile":10117.38,"90th_percentile":10117.38},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":5385.1,"10th_percentile":5385.1,"90th_percentile":5385.1,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13145.95,"10th_percentile":8978.43,"90th_percentile":13323.3,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":8209.45,"10th_percentile":8209.45,"90th_percentile":8209.45,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":26273.76,"10th_percentile":26273.76,"90th_percentile":26834.18,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"11","median_amount":13145.56,"10th_percentile":7519.47,"90th_percentile":13416.9,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":10416.8,"maximum":18913.02,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14366.13},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10416.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10416.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13984.51},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":14419.86},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15136.17},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10416.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10416.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":16452.36},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10416.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10416.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10416.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10416.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10416.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10416.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10416.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18913.02},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17275.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10416.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10960.07,"10th_percentile":10960.07,"90th_percentile":14367.46,"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":"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":8346.16,"10th_percentile":8346.16,"90th_percentile":8346.16,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8597.47,"10th_percentile":8597.47,"90th_percentile":8597.47,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":64476.1,"10th_percentile":43122.19,"90th_percentile":96964.14,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":14389.54,"10th_percentile":14389.54,"90th_percentile":14389.54},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":381.1,"10th_percentile":381.1,"90th_percentile":381.1,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8371.63,"10th_percentile":6236.41,"90th_percentile":8966.05,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":5973.24,"10th_percentile":5973.24,"90th_percentile":5973.24,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":18914.76,"10th_percentile":18914.76,"90th_percentile":18914.76,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"1 through 10","median_amount":17277.17,"10th_percentile":17277.17,"90th_percentile":17277.17,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6637.48,"10th_percentile":285.37,"90th_percentile":8642.48,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":8003.17,"maximum":13903.97,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10561.31},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8003.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8003.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10280.75},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":10600.81},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11127.41},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8003.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8003.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":12095.01},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8003.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8003.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8003.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8003.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8003.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8003.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8003.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13903.97},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12700.19},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8003.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":54332.88,"10th_percentile":54332.88,"90th_percentile":54332.88,"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":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":34165.24,"10th_percentile":34165.24,"90th_percentile":37321.75,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":4279.66,"10th_percentile":4279.66,"90th_percentile":4279.66,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":33778.27,"10th_percentile":27317.93,"90th_percentile":42262.83,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5866.21,"10th_percentile":5866.21,"90th_percentile":6455.31,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":7455.83,"10th_percentile":7455.83,"90th_percentile":7455.83,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6429.04,"10th_percentile":6429.04,"90th_percentile":6429.04,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":60905.14,"maximum":116927.95,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":88817.24},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60905.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60905.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":86457.9},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":89149.43},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":93577.96},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60905.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60905.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":101715.18},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60905.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60905.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60905.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60905.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60905.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60905.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60905.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":116927.95},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":106804.61},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60905.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":44855.59,"10th_percentile":44855.59,"90th_percentile":44855.59,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":20363.96,"10th_percentile":20363.96,"90th_percentile":20363.96,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":89360.35,"10th_percentile":89360.35,"90th_percentile":89360.35,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Spinal Fusion Except Cervical Without Mcc","code_information":[{"code":"448","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":38849.02,"maximum":71215.09,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54094.23},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38849.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38849.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":52657.27},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":54296.56},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":56993.75},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38849.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38849.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":61949.74},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38849.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38849.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38849.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38849.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38849.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38849.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38849.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":71215.09},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":65049.46},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38849.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":33257.67,"10th_percentile":31363.01,"90th_percentile":33355.88,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":149927.03,"10th_percentile":149927.03,"90th_percentile":167269.38,"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":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":134293.36,"10th_percentile":101465.76,"90th_percentile":141403.02,"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":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":18888.4,"10th_percentile":18888.4,"90th_percentile":18888.4,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":33257.67,"10th_percentile":33257.67,"90th_percentile":33257.67,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"16","median_amount":130306.91,"10th_percentile":77475.19,"90th_percentile":253091.85,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":25291.75,"10th_percentile":25291.75,"90th_percentile":25291.75},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27418.24,"10th_percentile":27418.24,"90th_percentile":27418.24,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"12","median_amount":31342.15,"10th_percentile":30768.85,"90th_percentile":31357.95,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5259.0,"10th_percentile":5259.0,"90th_percentile":5259.0,"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 Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":71220.32,"10th_percentile":71220.32,"90th_percentile":71220.32,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"1 through 10","median_amount":67560.18,"10th_percentile":67560.18,"90th_percentile":67560.18,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":31365.86,"10th_percentile":31052.68,"90th_percentile":33280.95,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Single Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody F","code_information":[{"code":"450","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":48687.89,"maximum":89815.92,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":68223.23},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48687.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48687.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":66410.94},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":68478.39},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":71880.08},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48687.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48687.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":78130.53},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48687.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48687.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48687.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48687.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48687.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48687.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48687.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":89815.92},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":82039.87},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48687.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":39425.59,"10th_percentile":39425.59,"90th_percentile":39425.59,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Single Level Spinal Fusion Except Cervical Without Mcc","code_information":[{"code":"451","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29718.61,"maximum":53819.44,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40880.68},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29718.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29718.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39794.72},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":41033.58},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43071.94},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29718.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29718.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":46817.33},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29718.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29718.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29718.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29718.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29718.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29718.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29718.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53819.44},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":49159.88},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29718.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":40877.39,"10th_percentile":37144.51,"90th_percentile":84811.85,"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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23779.5,"10th_percentile":23758.27,"90th_percentile":25499.81,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":91845.46,"10th_percentile":82717.72,"90th_percentile":146986.16,"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":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":100277.64,"10th_percentile":86652.93,"90th_percentile":163101.85,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":22438.76,"10th_percentile":22438.76,"90th_percentile":22438.76,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23853.13,"10th_percentile":23785.9,"90th_percentile":25476.14,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"12","median_amount":109903.02,"10th_percentile":92360.87,"90th_percentile":127780.09,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":35251.71,"10th_percentile":35251.71,"90th_percentile":38309.71},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":36617.63,"10th_percentile":36617.63,"90th_percentile":36617.63,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23762.17,"10th_percentile":23184.97,"90th_percentile":23787.3,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":18888.4,"10th_percentile":18888.4,"90th_percentile":32490.06,"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":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22438.76,"10th_percentile":22438.76,"90th_percentile":22438.76,"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 Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":19266.17,"10th_percentile":19266.17,"90th_percentile":19266.17,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":55246.49,"10th_percentile":53822.93,"90th_percentile":56341.41,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23782.01,"10th_percentile":23782.01,"90th_percentile":23819.01,"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":"Youthcare","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":"1 through 10","median_amount":47079.41,"10th_percentile":47079.41,"90th_percentile":47079.41,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":47746.99,"10th_percentile":47746.99,"90th_percentile":47746.99,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":133066.68,"10th_percentile":133066.68,"90th_percentile":133066.68,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":64720.28,"10th_percentile":64720.28,"90th_percentile":64720.28,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":65269.59,"10th_percentile":65269.59,"90th_percentile":65269.59,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","code_information":[{"code":"457","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":54412.47,"maximum":100093.9,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":76030.27},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54412.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54412.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":74010.6},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":76314.64},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":80105.59},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54412.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54412.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":87071.3},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54412.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54412.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54412.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54412.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54412.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54412.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54412.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":100093.9},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":91428.01},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54412.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":43875.42,"10th_percentile":43875.42,"90th_percentile":43875.42,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":254786.46,"10th_percentile":254786.46,"90th_percentile":254786.46,"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":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":202926.63,"10th_percentile":202926.63,"90th_percentile":202926.63,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":43533.6,"10th_percentile":43533.6,"90th_percentile":43533.6,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":154105.42,"10th_percentile":154105.42,"90th_percentile":154105.42,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":43893.08,"10th_percentile":43893.08,"90th_percentile":43893.08,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","code_information":[{"code":"458","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":38232.74,"maximum":75305.01,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57200.89},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38232.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38232.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":55681.4},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":57414.83},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":60266.93},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38232.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38232.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":65507.54},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38232.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38232.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38232.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38232.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38232.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38232.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38232.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":75305.01},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":68785.28},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38232.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":58818.94,"10th_percentile":58818.94,"90th_percentile":58818.94,"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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":237761.25,"10th_percentile":237761.25,"90th_percentile":237761.25,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":98954.84,"10th_percentile":98954.84,"90th_percentile":98954.84,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":33120.06,"10th_percentile":33120.06,"90th_percentile":33120.06,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc","code_information":[{"code":"461","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":50435.53,"maximum":107030.18,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":81299.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50435.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50435.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":79139.37},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":81603.08},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":85656.73},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50435.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50435.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":93105.15},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50435.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50435.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50435.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50435.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50435.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50435.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50435.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":107030.18},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":97763.77},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50435.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc","code_information":[{"code":"462","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24564.23,"maximum":49944.05,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37936.97},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24564.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24564.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36929.21},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":38078.86},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39970.44},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24564.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24564.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":43446.14},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24564.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24564.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24564.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24564.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24564.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24564.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24564.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49944.05},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":45620.01},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24564.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":112015.42,"10th_percentile":112015.42,"90th_percentile":112015.42,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","code_information":[{"code":"463","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":52030.46,"maximum":94193.61,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":71548.47},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52030.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52030.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":69647.86},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":71816.08},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":75383.56},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52030.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52030.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":81938.66},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52030.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52030.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52030.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52030.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52030.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52030.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52030.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":94193.61},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":86038.55},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52030.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":16282.75,"10th_percentile":16282.75,"90th_percentile":16282.75,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":44982.25,"10th_percentile":44982.25,"90th_percentile":44982.25,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":13024.75,"10th_percentile":13024.75,"90th_percentile":13024.75,"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":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","code_information":[{"code":"464","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28673.1,"maximum":51426.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39063.05},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28673.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28673.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38025.38},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":39209.16},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41156.88},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28673.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28673.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":44735.75},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28673.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28673.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28673.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28673.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28673.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28673.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28673.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51426.53},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":46974.15},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28673.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22731.48,"10th_percentile":22731.48,"90th_percentile":22731.48,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":84433.17,"10th_percentile":84433.17,"90th_percentile":84433.17,"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":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":1424.9,"10th_percentile":1424.9,"90th_percentile":1424.9,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":51426.53,"10th_percentile":51426.53,"90th_percentile":51426.53,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24563.68,"10th_percentile":24563.68,"90th_percentile":24563.68,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","code_information":[{"code":"465","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17007.07,"maximum":30275.83,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22997.2},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17007.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17007.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22386.31},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":23083.22},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24229.88},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17007.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17007.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":26336.83},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17007.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17007.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17007.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17007.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17007.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17007.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17007.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30275.83},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27654.62},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17007.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13494.08,"10th_percentile":13494.08,"90th_percentile":13494.08,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Revision Of Hip Or Knee Replacement With Mcc","code_information":[{"code":"466","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":47565.56,"maximum":88849.69,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67489.29},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47565.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47565.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":65696.5},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":67741.71},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":71106.8},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47565.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47565.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":77290.01},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47565.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47565.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47565.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47565.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47565.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47565.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47565.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":88849.69},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":81157.29},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47565.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":49785.23,"10th_percentile":49785.23,"90th_percentile":49785.23,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":115622.45,"10th_percentile":115622.45,"90th_percentile":118570.49,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25537.79,"10th_percentile":25537.79,"90th_percentile":25537.79,"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":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":99340.92,"10th_percentile":99340.92,"90th_percentile":195849.37,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17755.31,"10th_percentile":17755.31,"90th_percentile":17755.31,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":16296.51,"10th_percentile":16296.51,"90th_percentile":16296.51,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26256.72,"10th_percentile":26256.72,"90th_percentile":26327.62,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24984.25,"10th_percentile":24984.25,"90th_percentile":24984.25,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":21769.79,"10th_percentile":21769.79,"90th_percentile":21769.79,"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":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23751.5,"10th_percentile":23751.5,"90th_percentile":23751.5,"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 Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26359.14,"10th_percentile":20202.65,"90th_percentile":26873.31,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Revision Of Hip Or Knee Replacement Without Cc/Mcc","code_information":[{"code":"468","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25359.44,"maximum":45751.23,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34752.15},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25359.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25359.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33829.0},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":34882.13},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36614.91},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25359.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25359.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":39798.82},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25359.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25359.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25359.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25359.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25359.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25359.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25359.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45751.23},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41790.2},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25359.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":34753.48,"10th_percentile":34753.48,"90th_percentile":34753.48,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20269.52,"10th_percentile":20237.93,"90th_percentile":21737.59,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":80866.36,"10th_percentile":80866.36,"90th_percentile":80866.36,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":32230.48,"10th_percentile":32230.48,"90th_percentile":32230.48,"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":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":139513.39,"10th_percentile":139513.39,"90th_percentile":144799.16,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19925.15,"10th_percentile":19925.15,"90th_percentile":19925.15,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":9088.98,"10th_percentile":9088.98,"90th_percentile":9088.98,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20269.93,"10th_percentile":20080.41,"90th_percentile":20285.05,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":91.48,"10th_percentile":91.48,"90th_percentile":91.48,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":43868.63,"10th_percentile":43868.63,"90th_percentile":43868.63,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21732.59,"10th_percentile":21732.59,"90th_percentile":21732.59,"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":"Youthcare","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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25162.72,"10th_percentile":25162.72,"90th_percentile":25162.72,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":91181.51,"10th_percentile":91181.51,"90th_percentile":91181.51,"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":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24342.77,"10th_percentile":24342.77,"90th_percentile":24342.77,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":13721.71,"10th_percentile":13721.71,"90th_percentile":13721.71,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23452.87,"10th_percentile":23452.87,"90th_percentile":25199.92,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc","code_information":[{"code":"470","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17957.7,"maximum":32885.01,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24979.1},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17957.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17957.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24315.56},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":25072.53},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26318.02},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17957.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17957.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":28606.54},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17957.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17957.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17957.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17957.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17957.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17957.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17957.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32885.01},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30037.9},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17957.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24979.1,"10th_percentile":24979.1,"90th_percentile":24979.1,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":1093.17,"10th_percentile":1093.17,"90th_percentile":22073.78,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14676.68,"10th_percentile":13144.87,"90th_percentile":14970.77,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":92700.7,"10th_percentile":92700.7,"90th_percentile":92700.7,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":71150.97,"10th_percentile":67928.2,"90th_percentile":108848.22,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":11353.57,"10th_percentile":10138.51,"90th_percentile":11725.0,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14677.8,"10th_percentile":14666.82,"90th_percentile":14964.1,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14946.49,"10th_percentile":14946.49,"90th_percentile":14946.49,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":82724.56,"10th_percentile":65669.4,"90th_percentile":84570.29,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":28095.21,"10th_percentile":28095.21,"90th_percentile":32933.07},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":11336.22,"10th_percentile":11336.22,"90th_percentile":11336.22,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14473.72,"10th_percentile":14294.48,"90th_percentile":15096.44,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":10073.56,"10th_percentile":10015.02,"90th_percentile":15961.51,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":30104.9,"10th_percentile":30104.9,"90th_percentile":33641.94,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"16","median_amount":14664.82,"10th_percentile":14204.22,"90th_percentile":14677.81,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cervical Spinal Fusion With Mcc","code_information":[{"code":"471","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":44161.54,"maximum":84710.94,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64345.54},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44161.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44161.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":62636.26},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":64586.2},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":67794.54},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44161.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44161.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":73689.72},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44161.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44161.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44161.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44161.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44161.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44161.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44161.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":84710.94},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":77376.87},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44161.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":35460.54,"10th_percentile":35460.54,"90th_percentile":35460.54,"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":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":101168.75,"10th_percentile":101168.75,"90th_percentile":101168.75,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":37208.81,"10th_percentile":37208.81,"90th_percentile":37208.81,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cervical Spinal Fusion With Cc","code_information":[{"code":"472","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27149.56,"maximum":50526.58,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38379.46},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27149.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27149.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37359.94},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":38523.0},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40436.64},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27149.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27149.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":43952.88},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27149.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27149.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27149.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27149.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27149.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27149.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27149.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50526.58},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":46152.11},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27149.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":20516.97,"10th_percentile":20516.97,"90th_percentile":20516.97,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"12","median_amount":22328.16,"10th_percentile":18331.36,"90th_percentile":22348.12,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":162945.63,"10th_percentile":162945.63,"90th_percentile":162945.63,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":82653.06,"10th_percentile":82653.06,"90th_percentile":115172.57,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":19657.85,"10th_percentile":19657.85,"90th_percentile":19657.85,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22380.01,"10th_percentile":22347.36,"90th_percentile":23262.01,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":107761.43,"10th_percentile":68151.26,"90th_percentile":172694.14,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":52376.0,"10th_percentile":52376.0,"90th_percentile":52376.0},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22487.81,"10th_percentile":22487.81,"90th_percentile":22487.81,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":50530.07,"10th_percentile":49304.3,"90th_percentile":51382.93,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22342.37,"10th_percentile":22328.17,"90th_percentile":23293.62,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cervical Spinal Fusion Without Cc/Mcc","code_information":[{"code":"473","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22587.97,"maximum":41286.34,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31360.67},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22587.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22587.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30527.6},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":31477.96},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33041.64},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22587.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22587.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":35914.83},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22587.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22587.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22587.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22587.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22587.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22587.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22587.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41286.34},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37711.86},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22587.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":32316.89,"10th_percentile":32316.89,"90th_percentile":32316.89,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":105900.24,"10th_percentile":105900.24,"90th_percentile":105900.24,"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":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":90482.46,"10th_percentile":90482.46,"90th_percentile":90482.46,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":39417.21,"10th_percentile":39417.21,"90th_percentile":39417.21,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18590.54,"10th_percentile":18590.54,"90th_percentile":18590.54,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc","code_information":[{"code":"474","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":39319.82,"maximum":78212.42,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59409.33},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39319.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39319.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":57831.18},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":59631.53},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":62593.75},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39319.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39319.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":68036.69},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39319.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39319.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39319.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39319.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39319.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39319.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39319.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":78212.42},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":71440.98},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39319.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":53418.8,"10th_percentile":53418.8,"90th_percentile":53418.8,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":133235.03,"10th_percentile":133235.03,"90th_percentile":133235.03,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc","code_information":[{"code":"475","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21091.53,"maximum":37621.98,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28577.26},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21091.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21091.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27818.13},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":28684.15},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30109.04},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21091.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21091.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":32727.22},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21091.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21091.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21091.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21091.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21091.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21091.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21091.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37621.98},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34364.76},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21091.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16449.11,"10th_percentile":16449.11,"90th_percentile":16449.11,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/Mcc","code_information":[{"code":"476","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11192.12,"maximum":20283.88,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15407.42},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11192.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11192.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14998.14},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":15465.05},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16233.28},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11192.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11192.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":17644.87},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11192.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11192.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11192.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11192.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11192.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11192.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11192.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20283.88},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18527.75},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11192.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26372.23,"10th_percentile":26372.23,"90th_percentile":26372.23,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":91162.68,"10th_percentile":91162.68,"90th_percentile":91162.68,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":30677.42,"10th_percentile":30677.42,"90th_percentile":30677.42},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24488.58,"10th_percentile":24488.58,"90th_percentile":24488.58,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25180.91,"10th_percentile":25180.91,"90th_percentile":25180.91,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":115785.09,"10th_percentile":115785.09,"90th_percentile":115785.09,"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":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":53990.89,"10th_percentile":53990.89,"90th_percentile":53990.89,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24630.96,"10th_percentile":24630.96,"90th_percentile":24630.96,"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":"Youthcare","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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":33830.78,"10th_percentile":33830.78,"90th_percentile":33830.78},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":40787.52,"10th_percentile":40787.52,"90th_percentile":40787.52,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16626.93,"10th_percentile":16626.93,"90th_percentile":16626.93,"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":"Youthcare","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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13848.88,"10th_percentile":13848.88,"90th_percentile":13848.88,"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":"Youthcare","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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":99025.09,"10th_percentile":99025.09,"90th_percentile":99025.09,"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":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":80135.12,"10th_percentile":80135.12,"90th_percentile":80135.12,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21999.78,"10th_percentile":21999.78,"90th_percentile":21999.78,"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":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":67666.15,"10th_percentile":67666.15,"90th_percentile":67666.15,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22564.59,"10th_percentile":22564.59,"90th_percentile":22564.59,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22678.42,"10th_percentile":21342.49,"90th_percentile":22678.42,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":72088.05,"10th_percentile":72088.05,"90th_percentile":72088.05,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22017.4,"10th_percentile":22017.4,"90th_percentile":22017.4,"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":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22659.95,"10th_percentile":21042.95,"90th_percentile":23001.07,"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":"Youthcare","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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":32766.54,"10th_percentile":32766.54,"90th_percentile":32766.54,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"18","median_amount":15401.11,"10th_percentile":12402.84,"90th_percentile":16149.97,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":86041.12,"10th_percentile":86041.12,"90th_percentile":86041.12,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":80282.47,"10th_percentile":69397.63,"90th_percentile":85420.1,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15616.49,"10th_percentile":14678.37,"90th_percentile":15629.14,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"19","median_amount":63054.7,"10th_percentile":42825.78,"90th_percentile":98316.27,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":19336.95,"10th_percentile":19336.95,"90th_percentile":19336.95},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14799.31,"10th_percentile":14799.31,"90th_percentile":14799.31,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":28363.88,"10th_percentile":28363.88,"90th_percentile":28363.88,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14512.38,"10th_percentile":14512.38,"90th_percentile":14512.38,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"30","median_amount":15396.81,"10th_percentile":12344.43,"90th_percentile":16687.27,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26968.87,"10th_percentile":26968.87,"90th_percentile":26968.87,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15044.8,"10th_percentile":15044.8,"90th_percentile":15044.8,"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":"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":41960.36,"10th_percentile":41960.36,"90th_percentile":41960.36,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14471.29,"10th_percentile":14471.29,"90th_percentile":14471.29,"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":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":3222.5,"10th_percentile":3222.5,"90th_percentile":3222.5,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":31781.43,"10th_percentile":23841.78,"90th_percentile":34931.34,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"1 through 10","median_amount":31765.15,"10th_percentile":31765.15,"90th_percentile":31765.15,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"31","median_amount":16099.47,"10th_percentile":14139.47,"90th_percentile":16595.87,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":15265.75,"maximum":27668.4,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21016.63},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15265.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15265.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20458.34},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":21095.23},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22143.15},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15265.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15265.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":24068.64},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15265.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15265.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15265.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15265.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15265.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15265.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15265.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27668.4},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25272.94},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15265.75,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":12432.71,"10th_percentile":12432.71,"90th_percentile":12432.71,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12403.19,"10th_percentile":10523.01,"90th_percentile":12422.91,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12432.71,"10th_percentile":12432.71,"90th_percentile":12432.71,"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":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":55150.3,"10th_percentile":55150.3,"90th_percentile":55670.78,"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":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":56249.15,"10th_percentile":56249.15,"90th_percentile":91362.95,"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":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":91665.69,"10th_percentile":91665.69,"90th_percentile":91665.69,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13108.83,"10th_percentile":13108.83,"90th_percentile":13108.83,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":50854.68,"10th_percentile":39554.07,"90th_percentile":74824.27,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":25267.46,"10th_percentile":25267.46,"90th_percentile":25267.46,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12425.74,"10th_percentile":11583.69,"90th_percentile":14177.82,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12432.74,"10th_percentile":12432.74,"90th_percentile":12432.74,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":27831.98,"10th_percentile":27831.98,"90th_percentile":27831.98,"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":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12090.0,"10th_percentile":12090.0,"90th_percentile":12090.0,"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 Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":28034.75,"10th_percentile":28034.75,"90th_percentile":28034.75,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":27011.76,"10th_percentile":23399.56,"90th_percentile":36147.43,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11296.73,"10th_percentile":10586.4,"90th_percentile":12441.75,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":25575.41,"maximum":44441.41,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33757.23},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25575.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25575.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32860.5},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":33883.49},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35566.66},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25575.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25575.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":38659.42},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25575.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25575.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25575.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25575.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25575.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25575.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25575.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44441.41},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40593.78},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25575.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":96859.23,"10th_percentile":96859.23,"90th_percentile":96859.23,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19702.13,"10th_percentile":19696.86,"90th_percentile":19714.54,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":115639.17,"10th_percentile":115639.17,"90th_percentile":163203.75,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19708.13,"10th_percentile":19708.13,"90th_percentile":19708.13,"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":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":86804.79,"10th_percentile":86804.79,"90th_percentile":86804.79,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19706.03,"10th_percentile":19706.03,"90th_percentile":19706.03,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17292.65,"10th_percentile":17292.65,"90th_percentile":17292.65,"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 Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures With Principal Diagnosis Of Infection With Mcc","code_information":[{"code":"485","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29688.79,"maximum":56222.81,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42706.25},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29688.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29688.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41571.8},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":42865.98},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44995.36},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29688.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29688.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":48908.01},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29688.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29688.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29688.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29688.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29688.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29688.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29688.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56222.81},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":51355.17},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29688.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":99477.7,"10th_percentile":99477.7,"90th_percentile":99477.7,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":43661.42,"10th_percentile":43661.42,"90th_percentile":43661.42,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures With Principal Diagnosis Of Infection With Cc","code_information":[{"code":"486","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19423.41,"maximum":36987.13,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28095.03},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19423.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19423.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27348.72},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":28200.11},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29600.96},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19423.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19423.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":32174.96},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19423.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19423.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19423.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19423.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19423.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19423.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19423.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36987.13},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33784.87},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19423.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":28097.68,"10th_percentile":28097.68,"90th_percentile":28097.68,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16449.3,"10th_percentile":16449.3,"90th_percentile":16449.3,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":94795.79,"10th_percentile":94795.79,"90th_percentile":94795.79,"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":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":73387.81,"10th_percentile":73387.81,"90th_percentile":80739.54,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":26547.97,"10th_percentile":26547.97,"90th_percentile":26547.97},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16661.03,"10th_percentile":16661.03,"90th_percentile":16661.03,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":36890.62,"10th_percentile":36890.62,"90th_percentile":36890.62,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16454.71,"10th_percentile":16454.71,"90th_percentile":16480.86,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":14680.19,"maximum":27558.52,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20933.16},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14680.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14680.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20377.1},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":21011.46},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22055.21},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14680.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14680.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":23973.06},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14680.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14680.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14680.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14680.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14680.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14680.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14680.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27558.52},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25172.57},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14680.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":37153.26,"10th_percentile":37153.26,"90th_percentile":37153.26,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":15846.22,"10th_percentile":15846.22,"90th_percentile":15846.22},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures Without Principal Diagnosis Of Infection With Cc/Mcc","code_information":[{"code":"488","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16511.87,"maximum":34276.8,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26036.29},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16511.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16511.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25344.67},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":26133.68},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27431.87},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16511.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16511.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":29817.26},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16511.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16511.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16511.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16511.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16511.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16511.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16511.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34276.8},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31309.19},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16511.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":80924.17,"10th_percentile":80924.17,"90th_percentile":80924.17,"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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9769.22,"10th_percentile":9769.22,"90th_percentile":9769.22,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":32443.6,"10th_percentile":32443.6,"90th_percentile":32443.6,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12928.72,"10th_percentile":12928.72,"90th_percentile":12928.72,"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":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures Without Principal Diagnosis Of Infection Without Cc/Mcc","code_information":[{"code":"489","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10619.21,"maximum":21602.42,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16408.97},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10619.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10619.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15973.08},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":16470.35},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17288.52},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10619.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10619.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":18791.87},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10619.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10619.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10619.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10619.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10619.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10619.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10619.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21602.42},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19732.14},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10619.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9139.36,"10th_percentile":9139.36,"90th_percentile":9139.36,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":22465.38,"10th_percentile":22465.38,"90th_percentile":22465.38},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9779.65,"10th_percentile":9779.65,"90th_percentile":9779.65,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":21598.93,"10th_percentile":21598.93,"90th_percentile":21598.93,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27359.92,"10th_percentile":27359.92,"90th_percentile":27359.92,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":61335.7,"10th_percentile":61335.7,"90th_percentile":61335.7,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":29545.95,"10th_percentile":29545.95,"90th_percentile":29545.95,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":61936.48,"10th_percentile":61936.48,"90th_percentile":61936.48,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27040.39,"10th_percentile":27040.39,"90th_percentile":27304.35,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc","code_information":[{"code":"493","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23444.62,"maximum":41875.84,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31808.45},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23444.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23444.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30963.49},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":31927.42},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33513.42},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23444.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23444.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":36427.64},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23444.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23444.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23444.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23444.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23444.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23444.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23444.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41875.84},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38250.33},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23444.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":31808.44,"10th_percentile":31808.44,"90th_percentile":31808.44,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":12515.87,"10th_percentile":12515.87,"90th_percentile":17255.66,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15982.69,"10th_percentile":14682.06,"90th_percentile":20138.61,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":75762.16,"10th_percentile":75762.16,"90th_percentile":90457.95,"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":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":70827.47,"10th_percentile":70827.47,"90th_percentile":70827.47,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":23081.47,"10th_percentile":12409.34,"90th_percentile":61082.04,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18606.11,"10th_percentile":18606.11,"90th_percentile":18606.11,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":47381.6,"10th_percentile":47381.6,"90th_percentile":47381.6,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21191.67,"10th_percentile":21191.67,"90th_percentile":21191.67,"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":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":10517.85,"10th_percentile":10517.85,"90th_percentile":10517.85,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17300.82,"10th_percentile":17300.82,"90th_percentile":22447.84,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":18028.5,"10th_percentile":18028.5,"90th_percentile":18028.5,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16649.18,"10th_percentile":15994.26,"90th_percentile":20116.62,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/Mcc","code_information":[{"code":"494","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18658.93,"maximum":32885.01,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24979.1},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18658.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18658.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24315.56},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":25072.53},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26318.02},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18658.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18658.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":28606.54},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18658.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18658.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18658.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18658.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18658.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18658.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18658.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32885.01},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30037.9},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18658.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14672.4,"10th_percentile":14672.4,"90th_percentile":14672.4,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":59860.34,"10th_percentile":52188.88,"90th_percentile":99179.99,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15578.27,"10th_percentile":15578.27,"90th_percentile":15578.27,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":9150.06,"10th_percentile":9150.06,"90th_percentile":11589.47,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14679.87,"10th_percentile":14679.87,"90th_percentile":17150.31,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":14532.87,"10th_percentile":14532.87,"90th_percentile":14532.87,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14664.08,"10th_percentile":14664.08,"90th_percentile":14664.08,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Mcc","code_information":[{"code":"495","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33290.71,"maximum":61397.55,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46636.93},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33290.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33290.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":45398.07},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":46811.37},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":49136.73},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33290.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33290.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":53409.5},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33290.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33290.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33290.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33290.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33290.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33290.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33290.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61397.55},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":56081.9},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33290.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":25584.61,"10th_percentile":25584.61,"90th_percentile":25584.61,"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":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc","code_information":[{"code":"496","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16828.15,"maximum":34409.35,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26136.98},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16828.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16828.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25442.68},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":26234.74},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27537.96},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16828.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16828.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":29932.56},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16828.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16828.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16828.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16828.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16828.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16828.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16828.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34409.35},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31430.27},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16828.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10561.74,"10th_percentile":10561.74,"90th_percentile":10561.74,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":56663.99,"10th_percentile":56663.99,"90th_percentile":56663.99,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":1867.2,"10th_percentile":1867.2,"90th_percentile":1867.2,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/Mcc","code_information":[{"code":"497","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11446.05,"maximum":23423.26,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17792.06},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11446.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11446.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17319.44},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":17858.61},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18745.74},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11446.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11446.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":20375.81},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11446.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11446.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11446.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11446.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11446.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11446.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11446.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23423.26},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21395.33},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11446.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":"1 through 10","median_amount":6879.83,"10th_percentile":6879.83,"90th_percentile":6879.83,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19544.01,"10th_percentile":19544.01,"90th_percentile":19544.01,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":121492.89,"10th_percentile":121492.89,"90th_percentile":121492.89,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":37338.72,"10th_percentile":37338.72,"90th_percentile":37338.72,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":59850.06,"10th_percentile":59850.06,"90th_percentile":59850.06,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20900.48,"10th_percentile":20900.48,"90th_percentile":20900.48,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":29605.04,"10th_percentile":29605.04,"90th_percentile":29605.04,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":48490.16,"10th_percentile":48490.16,"90th_percentile":48490.16,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass Without Cardiac Catheterization Without Mcc","code_information":[{"code":"236","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":38379.13,"maximum":71713.9,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54473.13},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38379.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38379.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":53026.1},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":54676.87},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":57392.96},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38379.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38379.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":62383.65},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38379.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38379.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38379.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38379.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38379.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38379.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38379.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":71713.9},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":65505.09},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38379.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":53798.5,"10th_percentile":53798.5,"90th_percentile":53798.5,"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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":25680.5,"10th_percentile":25680.5,"90th_percentile":25680.5,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":31608.0,"10th_percentile":31608.0,"90th_percentile":31608.0,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":141945.81,"10th_percentile":141945.81,"90th_percentile":141945.81,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":153082.79,"10th_percentile":153082.79,"90th_percentile":153082.79,"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":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":31827.21,"10th_percentile":31827.21,"90th_percentile":31827.21,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":146580.66,"10th_percentile":134997.2,"90th_percentile":162187.1,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":34460.47,"10th_percentile":34460.47,"90th_percentile":34460.47},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":29476.5,"10th_percentile":26495.38,"90th_percentile":31550.16,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":54036.4,"10th_percentile":54036.4,"90th_percentile":54036.4,"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":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":28902.55,"10th_percentile":28902.55,"90th_percentile":28902.55,"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 Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":71719.14,"10th_percentile":71719.14,"90th_percentile":71719.14,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27276.46,"10th_percentile":27276.46,"90th_percentile":27276.46,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass Without Cardiac Catheterization With Mcc","code_information":[{"code":"235","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":53558.52,"maximum":102619.36,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":77948.58},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53558.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53558.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":75877.96},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":78240.12},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":82126.73},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53558.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53558.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":89268.19},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53558.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53558.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53558.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53558.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53558.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53558.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53558.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":102619.36},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":93734.82},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53558.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":72498.96,"10th_percentile":72498.96,"90th_percentile":72498.96,"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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":33369.93,"10th_percentile":33369.93,"90th_percentile":33369.93,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":29158.0,"10th_percentile":29158.0,"90th_percentile":29158.0,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":133708.53,"10th_percentile":133708.53,"90th_percentile":133708.53,"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":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":331668.05,"10th_percentile":331668.05,"90th_percentile":331668.05,"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":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":61392.43,"10th_percentile":61392.43,"90th_percentile":61392.43,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":42758.62,"10th_percentile":42758.62,"90th_percentile":42758.62,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":233677.26,"10th_percentile":194527.0,"90th_percentile":628739.78,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":36853.37,"10th_percentile":36853.37,"90th_percentile":36853.37,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":44903.47,"10th_percentile":33443.43,"90th_percentile":57237.9,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":48398.67,"10th_percentile":48398.67,"90th_percentile":48398.67,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":105931.41,"10th_percentile":105931.41,"90th_percentile":105931.41,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":102626.33,"10th_percentile":102626.33,"90th_percentile":102626.33,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":33461.13,"10th_percentile":33461.13,"90th_percentile":44990.82,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc","code_information":[{"code":"234","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":49890.64,"maximum":92784.38,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":70478.04},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49890.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49890.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":68605.86},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":70741.64},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":74255.75},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49890.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49890.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":80712.78},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49890.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49890.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49890.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49890.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49890.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49890.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49890.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":92784.38},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":84751.33},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49890.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":189552.63,"10th_percentile":189552.63,"90th_percentile":189552.63,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":38179.63,"10th_percentile":38179.63,"90th_percentile":38179.63,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":53521.32,"10th_percentile":53521.32,"90th_percentile":53521.32,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":40719.92,"10th_percentile":40719.92,"90th_percentile":40719.92,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc","code_information":[{"code":"233","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":69612.64,"maximum":136315.37,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":103543.72},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":69612.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":69612.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":100793.18},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":103930.99},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":109093.8},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":69612.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":69612.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":118580.22},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":69612.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":69612.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":69612.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":69612.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":69612.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":69612.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":69612.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":136315.37},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":124513.51},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":69612.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":59678.52,"10th_percentile":59678.52,"90th_percentile":59678.52,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":40731.02,"10th_percentile":40731.02,"90th_percentile":40731.02,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":249686.57,"10th_percentile":249686.57,"90th_percentile":249686.57,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":38316.38,"10th_percentile":38316.38,"90th_percentile":38316.38,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":49030.76,"10th_percentile":49030.76,"90th_percentile":49030.76,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":40499.16,"10th_percentile":40499.16,"90th_percentile":40499.16,"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 Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":91266.49,"10th_percentile":91266.49,"90th_percentile":136325.83,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"1 through 10","median_amount":124523.07,"10th_percentile":124523.07,"90th_percentile":124523.07,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":57820.72,"10th_percentile":57820.72,"90th_percentile":57820.72,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass With Ptca Without Mcc","code_information":[{"code":"232","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":55311.59,"maximum":106534.86,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":80922.76},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55311.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55311.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":78773.13},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":81225.42},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":85260.32},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55311.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55311.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":92674.27},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55311.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55311.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55311.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55311.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55311.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55311.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55311.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":106534.86},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":97311.33},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55311.59,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass With Ptca With Mcc","code_information":[{"code":"231","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":76703.53,"maximum":147784.57,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":112255.6},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":76703.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":76703.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":109273.64},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":112675.46},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":118272.65},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":76703.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":76703.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":128557.24},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":76703.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":76703.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":76703.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":76703.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":76703.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":76703.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":76703.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":147784.57},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":134989.74},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":76703.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cardiothoracic Procedures Without Mcc","code_information":[{"code":"229","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28987.57,"maximum":54173.49,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41149.61},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28987.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28987.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40056.51},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":41303.52},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43355.29},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28987.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28987.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":47125.31},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28987.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28987.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28987.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28987.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28987.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28987.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28987.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54173.49},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":49483.28},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28987.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":22290.95,"10th_percentile":22290.95,"90th_percentile":22290.95,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23933.43,"10th_percentile":23933.43,"90th_percentile":23933.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23937.45,"10th_percentile":23937.45,"90th_percentile":23937.45,"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":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":112830.12,"10th_percentile":112830.12,"90th_percentile":112830.12,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23227.83,"10th_percentile":23227.83,"90th_percentile":24058.15,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22290.95,"10th_percentile":22290.95,"90th_percentile":22290.95,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":40888.85,"10th_percentile":40888.85,"90th_percentile":40888.85,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":38612.92,"10th_percentile":38612.92,"90th_percentile":38612.92,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":53282.36,"10th_percentile":53282.36,"90th_percentile":53282.36,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23916.63,"10th_percentile":23916.63,"90th_percentile":23916.63,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cardiothoracic Procedures With Mcc","code_information":[{"code":"228","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":45234.16,"maximum":86906.76,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66013.46},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45234.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45234.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":64259.88},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":66260.36},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":69551.87},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45234.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45234.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":75599.86},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45234.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45234.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45234.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45234.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45234.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45234.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45234.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":86906.76},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":79382.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45234.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":38164.09,"10th_percentile":38164.09,"90th_percentile":38164.09,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":127880.08,"10th_percentile":127880.08,"90th_percentile":127880.08,"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":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":150766.28,"10th_percentile":150766.28,"90th_percentile":150766.28,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":23941.16,"10th_percentile":23941.16,"90th_percentile":23941.16,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":38217.84,"10th_percentile":38145.58,"90th_percentile":45269.26,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"1 through 10","median_amount":79173.8,"10th_percentile":79173.8,"90th_percentile":79173.8,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":222133.46,"10th_percentile":222133.46,"90th_percentile":222133.46,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc","code_information":[{"code":"220","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":48716.8,"maximum":92372.77,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":70165.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48716.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48716.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":68301.51},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":70427.81},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":73926.34},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48716.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48716.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":80354.72},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48716.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48716.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48716.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48716.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48716.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48716.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48716.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":92372.77},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":84375.36},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48716.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":64731.92,"10th_percentile":64731.92,"90th_percentile":64731.92,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":32383.69,"10th_percentile":32383.69,"90th_percentile":32383.69,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":145222.69,"10th_percentile":145222.69,"90th_percentile":145222.69,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":206922.31,"10th_percentile":206922.31,"90th_percentile":206922.31,"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":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":187083.92,"10th_percentile":131117.73,"90th_percentile":329239.09,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":167076.96,"10th_percentile":167076.96,"90th_percentile":167076.96},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":40560.18,"10th_percentile":35187.33,"90th_percentile":186972.44,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":41590.9,"10th_percentile":41590.9,"90th_percentile":101059.39,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":88190.06,"10th_percentile":88190.06,"90th_percentile":88190.06,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"1 through 10","median_amount":84381.73,"10th_percentile":84381.73,"90th_percentile":84381.73,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":41702.52,"10th_percentile":40540.16,"90th_percentile":126495.85,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Mcc","code_information":[{"code":"219","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":69911.75,"maximum":134941.02,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":102499.78},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":69911.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":69911.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":99776.97},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":102883.14},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":107993.9},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":69911.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":69911.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":117384.68},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":69911.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":69911.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":69911.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":69911.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":69911.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":69911.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":69911.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":134941.02},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":123258.15},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":69911.75,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":237872.38,"10th_percentile":237872.38,"90th_percentile":237872.38,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":57272.41,"10th_percentile":57272.41,"90th_percentile":57272.41,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":278040.43,"10th_percentile":278040.43,"90th_percentile":278040.43,"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":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":252194.0,"10th_percentile":132087.22,"90th_percentile":638237.9,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":101215.94,"10th_percentile":101215.94,"90th_percentile":117248.83,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":134949.74,"10th_percentile":134949.74,"90th_percentile":134949.74,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":58992.05,"10th_percentile":58992.05,"90th_percentile":122450.48,"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":"Youthcare","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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":45487.91,"10th_percentile":45487.91,"90th_percentile":45487.91,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc","code_information":[{"code":"217","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":59944.57,"maximum":112623.51,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":85547.64},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59944.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59944.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":83275.15},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":85867.6},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":90133.1},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59944.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59944.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":97970.77},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59944.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59944.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59944.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59944.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59944.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59944.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59944.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":112623.51},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":102872.84},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59944.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":302029.73,"10th_percentile":302029.73,"90th_percentile":302029.73,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Mcc","code_information":[{"code":"216","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":88928.92,"maximum":168312.63,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":127848.5},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":88928.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":88928.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":124452.33},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":128326.68},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":134701.34},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":88928.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":88928.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":146414.52},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":88928.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":88928.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":88928.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":88928.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":88928.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":88928.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":88928.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":168312.63},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":153740.52},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":88928.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":245743.1,"10th_percentile":245743.1,"90th_percentile":245743.1,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":219086.05,"10th_percentile":219086.05,"90th_percentile":219086.05,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":73530.38,"10th_percentile":73530.38,"90th_percentile":73530.38,"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":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":160690.82,"10th_percentile":160690.82,"90th_percentile":160690.82,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":71938.62,"10th_percentile":71938.62,"90th_percentile":71938.62,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Heart Assist System Implant","code_information":[{"code":"215","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":90503.06,"maximum":184773.44,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":140351.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90503.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90503.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":136623.65},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":140876.9},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":147875.01},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90503.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90503.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":160733.72},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90503.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90503.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90503.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90503.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90503.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90503.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90503.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":184773.44},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":168776.2},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90503.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":80708.22,"10th_percentile":80708.22,"90th_percentile":166557.84,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":334763.45,"10th_percentile":334763.45,"90th_percentile":334763.45,"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":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":132295.43,"10th_percentile":132295.43,"90th_percentile":132295.43,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":480001.67,"10th_percentile":480001.67,"90th_percentile":480001.67,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":80510.77,"10th_percentile":80510.77,"90th_percentile":80510.77,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":31190.04,"10th_percentile":31190.04,"90th_percentile":31190.04,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":184783.91,"10th_percentile":184783.91,"90th_percentile":184783.91,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":78885.42,"10th_percentile":78885.42,"90th_percentile":78885.42,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concomitant Aortic And Mitral Valve Procedures","code_information":[{"code":"212","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":98790.37,"maximum":189986.56,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":144311.79},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98790.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98790.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":140478.29},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":144851.54},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":152047.09},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98790.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98790.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":165268.59},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98790.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98790.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98790.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98790.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98790.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98790.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98790.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":189986.56},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":173537.98},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98790.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":13002.32,"10th_percentile":13002.32,"90th_percentile":14676.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20855.99,"10th_percentile":20855.99,"90th_percentile":21756.16,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":88463.92,"10th_percentile":88463.92,"90th_percentile":88463.92,"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":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23297.21,"10th_percentile":23297.21,"90th_percentile":23297.21,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":91383.18,"10th_percentile":85028.45,"90th_percentile":140797.05,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20812.55,"10th_percentile":20812.55,"90th_percentile":20812.55,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21739.67,"10th_percentile":20753.7,"90th_percentile":23338.37,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":38991.12,"10th_percentile":38991.12,"90th_percentile":38991.12,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":10441.62,"10th_percentile":10441.62,"90th_percentile":10441.62,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18254.86,"10th_percentile":18254.86,"90th_percentile":18254.86,"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 Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"1 through 10","median_amount":43789.54,"10th_percentile":43789.54,"90th_percentile":43789.54,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20727.51,"10th_percentile":19915.19,"90th_percentile":21737.99,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory System Diagnosis With Ventilator Support >96 Hours","code_information":[{"code":"207","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":58674.05,"maximum":112803.16,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":85684.09},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58674.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58674.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":83407.98},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":86004.56},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":90276.87},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58674.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58674.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":98127.04},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58674.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58674.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58674.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58674.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58674.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58674.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58674.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":112803.16},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":103036.93},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58674.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":26816.93,"10th_percentile":26816.93,"90th_percentile":26816.93,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":49516.78,"10th_percentile":49516.78,"90th_percentile":49516.78,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":75627.13,"10th_percentile":75627.13,"90th_percentile":75627.13,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15276.92,"10th_percentile":15276.92,"90th_percentile":15276.92,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":34460.33,"10th_percentile":34460.33,"90th_percentile":34460.33,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":49205.01,"10th_percentile":49205.01,"90th_percentile":49205.01,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":46645.85,"10th_percentile":46645.85,"90th_percentile":46645.85,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":112227.6,"10th_percentile":112227.6,"90th_percentile":112227.6,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":42482.29,"10th_percentile":42482.29,"90th_percentile":42482.29,"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":"Youthcare","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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":4691.77,"10th_percentile":4691.77,"90th_percentile":6446.69,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":1099.12,"10th_percentile":1099.12,"90th_percentile":1099.12,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6571.31,"10th_percentile":1411.72,"90th_percentile":7266.42,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7264.38,"10th_percentile":7264.38,"90th_percentile":7264.38,"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":"Youthcare","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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6817.95,"10th_percentile":6817.95,"90th_percentile":6817.95,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"Youthcare","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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":35624.48,"10th_percentile":35624.48,"90th_percentile":35624.48,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":4151.01,"10th_percentile":4151.01,"90th_percentile":4151.01,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6541.61,"10th_percentile":6541.61,"90th_percentile":6541.61,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bronchitis And Asthma Without Cc/Mcc","code_information":[{"code":"203","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6581.74,"maximum":12144.17,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9224.58},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6581.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6581.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8979.54},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":9259.08},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9719.03},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6581.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6581.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10564.17},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6581.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6581.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6581.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6581.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6581.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6581.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6581.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12144.17},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11092.76},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6581.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8247.41,"10th_percentile":5315.98,"90th_percentile":8579.26,"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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":2805.67,"10th_percentile":2805.67,"90th_percentile":2932.92,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5669.62,"10th_percentile":5669.62,"90th_percentile":5669.62,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":12983.05,"10th_percentile":12983.05,"90th_percentile":18007.59,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12646.97,"10th_percentile":12646.97,"90th_percentile":13779.14,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":21119.7,"10th_percentile":12496.51,"90th_percentile":35857.22,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":4074.68,"10th_percentile":4074.68,"90th_percentile":4074.68},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":3684.48,"10th_percentile":3684.48,"90th_percentile":3684.48,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5483.41,"10th_percentile":5483.41,"90th_percentile":5667.94,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":2844.7,"10th_percentile":953.0,"90th_percentile":3959.11,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":12149.4,"10th_percentile":10719.37,"90th_percentile":12149.4,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":9303.51,"maximum":16860.21,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12806.84},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9303.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9303.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12466.64},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":12854.74},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13493.3},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9303.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9303.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":14666.64},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9303.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9303.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9303.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9303.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9303.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9303.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9303.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16860.21},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15400.5},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9303.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9228.56,"10th_percentile":9228.56,"90th_percentile":12806.84,"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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":5213.96,"10th_percentile":4280.49,"90th_percentile":22174.84,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7711.84,"10th_percentile":7711.84,"90th_percentile":7711.84,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6062.66,"10th_percentile":6062.66,"90th_percentile":6062.66,"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":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":14720.95,"10th_percentile":14720.95,"90th_percentile":14720.95,"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":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17077.41,"10th_percentile":4380.4,"90th_percentile":26271.68,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"12","median_amount":20071.81,"10th_percentile":11459.66,"90th_percentile":48132.86,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":4511.09,"10th_percentile":4511.09,"90th_percentile":4511.09},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":3038.36,"10th_percentile":3038.36,"90th_percentile":3724.67,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7449.49,"10th_percentile":7352.43,"90th_percentile":7711.84,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6068.79,"10th_percentile":6068.79,"90th_percentile":6068.79,"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":"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":"18","median_amount":4089.07,"10th_percentile":2941.82,"90th_percentile":5505.3,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7960.0,"10th_percentile":7960.0,"90th_percentile":7960.0,"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 Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":4995.08,"10th_percentile":4995.08,"90th_percentile":4995.08,"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":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":15307.15,"10th_percentile":15307.15,"90th_percentile":15307.15,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"1 through 10","median_amount":13600.53,"10th_percentile":10902.35,"90th_percentile":15100.5,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"12","median_amount":6210.84,"10th_percentile":194.67,"90th_percentile":7711.84,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pneumothorax Without Cc/Mcc","code_information":[{"code":"201","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6989.28,"maximum":11805.81,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8967.57},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6989.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6989.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8729.36},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":9001.11},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9448.24},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6989.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6989.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10269.83},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6989.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6989.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6989.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6989.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6989.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6989.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6989.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11805.81},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10783.69},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6989.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5529.49,"10th_percentile":5529.49,"90th_percentile":5529.49,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15072.81,"10th_percentile":15072.81,"90th_percentile":15072.81,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":14468.87,"10th_percentile":14468.87,"90th_percentile":14468.87,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":7049.33,"10th_percentile":7049.33,"90th_percentile":7049.33},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"1 through 10","median_amount":8767.32,"10th_percentile":8767.32,"90th_percentile":8767.32,"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":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pneumothorax With Cc","code_information":[{"code":"200","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10461.08,"maximum":19314.16,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14670.84},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10461.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10461.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14281.12},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":14725.71},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15457.21},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10461.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10461.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":16801.32},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10461.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10461.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10461.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10461.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10461.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10461.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10461.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19314.16},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17641.99},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10461.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7521.31,"10th_percentile":7521.31,"90th_percentile":7521.31,"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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7974.89,"10th_percentile":7974.89,"90th_percentile":8784.07,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":5030.17,"10th_percentile":5030.17,"90th_percentile":5030.17,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":23233.9,"10th_percentile":23233.9,"90th_percentile":26043.94,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8587.66,"10th_percentile":8587.66,"90th_percentile":8587.66,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9013.36,"10th_percentile":9013.36,"90th_percentile":9013.36,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6568.39,"10th_percentile":6568.39,"90th_percentile":6568.39,"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":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":2472.71,"10th_percentile":2472.71,"90th_percentile":2472.71,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8794.33,"10th_percentile":8781.17,"90th_percentile":9003.88,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pneumothorax With Mcc","code_information":[{"code":"199","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16468.5,"maximum":30786.85,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23385.37},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16468.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16468.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22764.16},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":23472.84},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24638.86},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16468.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16468.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":26781.37},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16468.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16468.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16468.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16468.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16468.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16468.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16468.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30786.85},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28121.4},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16468.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13803.33,"10th_percentile":13803.33,"90th_percentile":13803.33,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13695.68,"10th_percentile":13695.68,"90th_percentile":13695.68,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":106905.39,"10th_percentile":106905.39,"90th_percentile":106905.39,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":5151.37,"10th_percentile":5151.37,"90th_percentile":5151.37,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8458.78,"10th_percentile":8458.78,"90th_percentile":8458.78,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13907.85,"10th_percentile":13907.85,"90th_percentile":13907.85,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/Mcc","code_information":[{"code":"499","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14969.77,"maximum":20245.51,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15378.28},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18733.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18733.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14969.77},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":15435.8},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16202.57},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18733.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18733.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":17611.5},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18733.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18733.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18733.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18733.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18733.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18733.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18733.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20245.51},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18492.7},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18733.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Soft Tissue Procedures With Mcc","code_information":[{"code":"500","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29125.82,"maximum":55261.81,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41976.29},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29125.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29125.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40861.23},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":42133.29},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44226.27},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29125.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29125.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":48072.04},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29125.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29125.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29125.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29125.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29125.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29125.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29125.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55261.81},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":50477.37},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29125.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24433.66,"10th_percentile":24433.66,"90th_percentile":24433.66,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17176.16,"10th_percentile":17176.16,"90th_percentile":17176.16,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Soft Tissue Procedures With Cc","code_information":[{"code":"501","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16323.91,"maximum":31130.44,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23646.36},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16323.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16323.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23018.21},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":23734.8},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24913.83},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16323.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16323.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":27080.25},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16323.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16323.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16323.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16323.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16323.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16323.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16323.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31130.44},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28435.24},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16323.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18510.1,"10th_percentile":18510.1,"90th_percentile":18510.1,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13901.3,"10th_percentile":13901.3,"90th_percentile":13901.3,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":146468.89,"10th_percentile":146468.89,"90th_percentile":146468.89,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":43355.15,"10th_percentile":34405.99,"90th_percentile":135682.17,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13186.01,"10th_percentile":13186.01,"90th_percentile":13186.01,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Soft Tissue Procedures Without Cc/Mcc","code_information":[{"code":"502","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12689.46,"maximum":24366.82,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18508.78},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12689.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12689.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18017.11},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":18578.01},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19500.88},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12689.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12689.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":21196.61},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12689.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12689.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12689.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12689.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12689.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12689.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12689.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24366.82},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22257.2},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12689.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17918.14,"10th_percentile":17918.14,"90th_percentile":17918.14,"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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":43743.83,"10th_percentile":43743.83,"90th_percentile":43743.83,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":45973.45,"10th_percentile":45973.45,"90th_percentile":45973.45,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10974.87,"10th_percentile":10974.87,"90th_percentile":10974.87,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Foot Procedures With Mcc","code_information":[{"code":"503","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25748.91,"maximum":46157.61,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35060.83},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25748.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25748.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34129.48},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":35191.97},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36940.14},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25748.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25748.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":40152.33},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25748.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25748.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25748.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25748.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25748.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25748.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25748.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46157.61},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":42161.39},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25748.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Foot Procedures With Cc","code_information":[{"code":"504","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17418.22,"maximum":30619.42,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23258.19},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17418.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17418.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22640.36},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":23345.18},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24504.86},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17418.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17418.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":26635.72},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17418.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17418.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17418.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17418.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17418.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17418.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17418.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30619.42},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27968.46},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17418.22,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":39197.7,"10th_percentile":39197.7,"90th_percentile":39197.7,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13731.61,"10th_percentile":13731.61,"90th_percentile":13731.61,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12451.32,"10th_percentile":12451.32,"90th_percentile":12451.32,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":16727.84,"maximum":30619.42,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23258.19},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16727.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16727.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22640.36},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":23345.18},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24504.86},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16727.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16727.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":26635.72},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16727.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16727.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16727.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16727.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16727.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16727.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16727.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30619.42},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27968.46},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16727.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2470.0,"10th_percentile":2470.0,"90th_percentile":2470.0,"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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Thumb Or Joint Procedures","code_information":[{"code":"506","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12719.28,"maximum":26144.06,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19858.75},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12719.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12719.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19331.22},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":19933.03},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20923.21},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12719.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12719.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":22742.62},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12719.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12719.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12719.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12719.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12719.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12719.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12719.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26144.06},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23880.57},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12719.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":65490.88,"10th_percentile":65490.88,"90th_percentile":65490.88,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":5149.35,"10th_percentile":5149.35,"90th_percentile":5149.35,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11742.96,"10th_percentile":11742.96,"90th_percentile":11742.96,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Shoulder Or Elbow Joint Procedures With Cc/Mcc","code_information":[{"code":"507","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16850.74,"maximum":33802.4,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25675.95},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16850.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16850.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24993.89},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":25771.98},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27052.21},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16850.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16850.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":29404.58},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16850.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16850.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16850.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16850.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16850.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16850.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16850.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33802.4},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30875.87},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16850.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Shoulder Or Elbow Joint Procedures Without Cc/Mcc","code_information":[{"code":"508","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14212.1,"maximum":22509.35,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17097.87},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14212.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14212.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16643.68},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":17161.82},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18014.34},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14212.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14212.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":19580.8},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14212.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14212.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14212.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14212.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14212.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14212.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14212.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22509.35},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20560.55},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14212.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Arthroscopy","code_information":[{"code":"509","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22651.96,"maximum":30635.12,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23270.11},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22651.96},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":23357.15},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24517.42},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":26649.37},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30635.12},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27982.8}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc","code_information":[{"code":"510","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27821.87,"maximum":49846.38,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37862.78},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27821.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27821.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36857.0},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":38004.4},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39892.28},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27821.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27821.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":43361.18},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27821.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27821.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27821.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27821.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27821.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27821.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27821.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49846.38},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":45530.8},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27821.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22041.0,"10th_percentile":22041.0,"90th_percentile":22041.0,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc","code_information":[{"code":"511","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19317.68,"maximum":34208.78,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25984.63},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19317.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19317.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25294.37},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":26081.81},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27377.44},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19317.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19317.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":29758.09},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19317.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19317.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19317.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19317.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19317.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19317.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19317.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34208.78},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31247.06},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19317.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20524.8,"10th_percentile":20524.8,"90th_percentile":20524.8,"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":"Aetna","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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":90906.73,"10th_percentile":90906.73,"90th_percentile":90906.73,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15249.93,"10th_percentile":15249.93,"90th_percentile":15249.93,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15251.73,"10th_percentile":15251.73,"90th_percentile":15251.73,"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":"Youthcare","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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/Mcc","code_information":[{"code":"513","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14753.38,"maximum":26257.43,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19944.86},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14753.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14753.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19415.05},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":20019.46},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21013.93},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14753.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14753.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":22841.24},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14753.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14753.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14753.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14753.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14753.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14753.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14753.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26257.43},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23984.12},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14753.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":7672.92,"10th_percentile":7672.92,"90th_percentile":7672.92,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":5638.68,"10th_percentile":5638.68,"90th_percentile":5638.68,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":48279.78,"10th_percentile":48279.78,"90th_percentile":48279.78,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":7204.85,"10th_percentile":7204.85,"90th_percentile":7204.85,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":10807.19,"10th_percentile":10807.19,"90th_percentile":10807.19,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/Mcc","code_information":[{"code":"514","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9765.27,"maximum":17782.84,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13507.66},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9765.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9765.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13148.84},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":13558.18},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14231.69},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9765.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9765.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":15469.23},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9765.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9765.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9765.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9765.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9765.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9765.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9765.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17782.84},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16243.25},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9765.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":2317.3,"10th_percentile":2317.3,"90th_percentile":2317.3,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8106.41,"10th_percentile":8106.41,"90th_percentile":8106.41,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":9843.98,"10th_percentile":9843.98,"90th_percentile":9843.98,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23092.53,"10th_percentile":23092.53,"90th_percentile":23092.53,"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":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":31949.88,"10th_percentile":31949.88,"90th_percentile":31949.88,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":53934.55,"10th_percentile":53934.55,"90th_percentile":53934.55,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":68621.6,"10th_percentile":68621.6,"90th_percentile":68621.6,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14158.59,"10th_percentile":14158.59,"90th_percentile":14158.59,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":83573.27,"10th_percentile":83573.27,"90th_percentile":83573.27,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15650.4,"10th_percentile":12380.8,"90th_percentile":16561.09,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":6445.12,"10th_percentile":6445.12,"90th_percentile":6445.12,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15620.75,"10th_percentile":14183.0,"90th_percentile":16560.65,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/Mcc","code_information":[{"code":"517","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14413.61,"maximum":26032.44,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19773.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14413.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14413.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19248.69},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":19847.92},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20833.87},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14413.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14413.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":22645.52},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14413.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14413.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14413.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14413.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14413.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14413.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14413.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26032.44},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23778.61},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14413.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":9739.77,"10th_percentile":9739.77,"90th_percentile":9739.77,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11643.77,"10th_percentile":11643.77,"90th_percentile":11643.77,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":74970.54,"10th_percentile":74970.54,"90th_percentile":74970.54,"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":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":262.4,"10th_percentile":262.4,"90th_percentile":262.4,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":49520.12,"10th_percentile":49520.12,"90th_percentile":62018.61,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11697.28,"10th_percentile":11697.28,"90th_percentile":11697.28,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10651.37,"10th_percentile":10558.01,"90th_percentile":11694.28,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":34299.18,"maximum":62505.06,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47478.18},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34299.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34299.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":46216.97},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":47655.76},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":50023.07},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34299.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34299.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":54372.91},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34299.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34299.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34299.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34299.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34299.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34299.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34299.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62505.06},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":57093.52},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34299.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21200.07,"10th_percentile":21200.07,"90th_percentile":21200.07,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":95416.48,"10th_percentile":95416.48,"90th_percentile":95416.48,"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":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":10264.17,"10th_percentile":10264.17,"90th_percentile":10264.17,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":83889.26,"10th_percentile":80087.66,"90th_percentile":190273.12,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27557.77,"10th_percentile":27557.77,"90th_percentile":27557.77,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":18602.0,"maximum":34388.42,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26121.08},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18602.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18602.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25427.2},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":26218.78},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27521.21},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18602.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18602.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":29914.36},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18602.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18602.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18602.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18602.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18602.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18602.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18602.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34388.42},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31411.15},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18602.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26123.73,"10th_percentile":26123.73,"90th_percentile":26123.73,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14167.25,"10th_percentile":14167.25,"90th_percentile":14167.25,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":67535.37,"10th_percentile":67535.37,"90th_percentile":67535.37,"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":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":57090.76,"10th_percentile":56107.43,"90th_percentile":57307.32,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":20609.46,"10th_percentile":20609.46,"90th_percentile":20609.46},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":9326.05,"10th_percentile":9326.05,"90th_percentile":9326.05,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15348.14,"10th_percentile":15348.14,"90th_percentile":15348.14,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":14026.85,"maximum":24994.7,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18985.71},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14026.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14026.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18481.37},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":19056.72},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20003.37},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14026.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14026.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":21742.79},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14026.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14026.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14026.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14026.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14026.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14026.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14026.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24994.7},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22830.72},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14026.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18987.03,"10th_percentile":18987.03,"90th_percentile":18987.03,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10219.66,"10th_percentile":10219.66,"90th_percentile":11262.66,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":49607.77,"10th_percentile":49607.77,"90th_percentile":57681.02,"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":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":45443.24,"10th_percentile":45443.24,"90th_percentile":45443.24,"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":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":65230.97,"10th_percentile":56887.11,"90th_percentile":84870.73,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11275.96,"10th_percentile":11275.96,"90th_percentile":11275.96,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":9899.43,"10th_percentile":9899.43,"90th_percentile":9899.43,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":24996.44,"10th_percentile":24996.44,"90th_percentile":24996.44,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":26463.69,"maximum":50833.54,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38612.62},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26463.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26463.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37586.91},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":38757.04},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40682.31},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26463.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26463.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":44219.9},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26463.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26463.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26463.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26463.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26463.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26463.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26463.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50833.54},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":46432.49},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26463.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":127601.32,"10th_percentile":127601.32,"90th_percentile":127601.32,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22117.82,"10th_percentile":22117.82,"90th_percentile":22117.82,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21377.53,"10th_percentile":16272.94,"90th_percentile":22413.25,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":25536.55,"10th_percentile":25536.55,"90th_percentile":25536.55,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16777.27,"10th_percentile":16777.27,"90th_percentile":22460.71,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc","code_information":[{"code":"522","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19663.78,"maximum":36769.12,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27929.43},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19663.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19663.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27187.52},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":28033.89},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29426.49},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19663.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19663.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":31985.32},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19663.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19663.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19663.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19663.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19663.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19663.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19663.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36769.12},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33585.73},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19663.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":32983.45,"10th_percentile":32983.45,"90th_percentile":32983.45,"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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":12167.24,"10th_percentile":12167.24,"90th_percentile":12167.24,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"12","median_amount":16365.45,"10th_percentile":15163.69,"90th_percentile":16401.92,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14722.97,"10th_percentile":14722.97,"90th_percentile":16908.86,"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":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":95677.09,"10th_percentile":95677.09,"90th_percentile":95677.09,"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":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":13000.16,"10th_percentile":13000.16,"90th_percentile":13000.16,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16254.94,"10th_percentile":15902.25,"90th_percentile":21577.98,"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":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16360.4,"10th_percentile":16360.4,"90th_percentile":16360.4,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":78607.21,"10th_percentile":64927.96,"90th_percentile":88629.53,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16385.54,"10th_percentile":16089.95,"90th_percentile":16698.95,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":16299.23,"10th_percentile":16299.23,"90th_percentile":16299.23,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"14","median_amount":16365.44,"10th_percentile":14649.19,"90th_percentile":16885.9,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":10548.68,"10th_percentile":10548.68,"90th_percentile":12651.23,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13986.68,"10th_percentile":13986.68,"90th_percentile":13986.68,"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 Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":32155.85,"10th_percentile":32155.85,"90th_percentile":32155.85,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"16","median_amount":16364.19,"10th_percentile":14429.95,"90th_percentile":16890.1,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fractures Of Femur With Mcc","code_information":[{"code":"533","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14693.74,"maximum":26594.04,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20200.55},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14693.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14693.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19663.94},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":20276.1},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21283.33},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14693.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14693.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":23134.05},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14693.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14693.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14693.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14693.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14693.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14693.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14693.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26594.04},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24291.59},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14693.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8471.3,"10th_percentile":8471.3,"90th_percentile":8471.3,"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":"Youthcare","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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":32284.98,"10th_percentile":32284.98,"90th_percentile":32284.98,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6560.23,"10th_percentile":6560.23,"90th_percentile":6560.23,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":956.32,"10th_percentile":956.32,"90th_percentile":956.32,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fractures Of Hip And Pelvis With Mcc","code_information":[{"code":"535","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12112.03,"maximum":23194.79,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17618.52},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12112.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12112.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17150.5},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":17684.41},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18562.89},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12112.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12112.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":20177.06},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12112.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12112.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12112.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12112.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12112.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12112.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12112.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23194.79},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21186.64},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12112.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9919.75,"10th_percentile":9919.75,"90th_percentile":10415.19,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":6591.28,"10th_percentile":6591.28,"90th_percentile":6591.28,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":75394.53,"10th_percentile":75394.53,"90th_percentile":75394.53,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10414.4,"10th_percentile":10414.4,"90th_percentile":10414.4,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6525.04,"10th_percentile":6525.04,"90th_percentile":6525.04,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System O.R. Procedures With Mcc","code_information":[{"code":"166","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":34302.79,"maximum":67165.29,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51018.05},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34302.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34302.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":49662.8},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":51208.87},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":53752.68},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34302.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34302.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":58426.83},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34302.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34302.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34302.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34302.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34302.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34302.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34302.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67165.29},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":61350.28},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34302.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":29574.14,"10th_percentile":29574.14,"90th_percentile":41285.27,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10878.68,"10th_percentile":10878.68,"90th_percentile":10878.68,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22572.96,"10th_percentile":22572.96,"90th_percentile":22572.96,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Procedures Without Cc/Mcc","code_information":[{"code":"165","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17824.86,"maximum":32508.28,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24692.95},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17824.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17824.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24037.0},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":24785.3},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26016.52},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17824.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17824.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":28278.83},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17824.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17824.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17824.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17824.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17824.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17824.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17824.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32508.28},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29693.79},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17824.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24482.3,"10th_percentile":24482.3,"90th_percentile":24482.3,"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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":8159.55,"10th_percentile":8159.55,"90th_percentile":8159.55,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14514.8,"10th_percentile":14300.8,"90th_percentile":15295.28,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15295.28,"10th_percentile":15295.28,"90th_percentile":15295.28,"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":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":73248.94,"10th_percentile":73248.94,"90th_percentile":73248.94,"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":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":73606.16,"10th_percentile":47435.31,"90th_percentile":84241.39,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":11203.63,"10th_percentile":11203.63,"90th_percentile":11203.63,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15295.28,"10th_percentile":15295.28,"90th_percentile":15295.28,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"13","median_amount":72560.24,"10th_percentile":59179.09,"90th_percentile":93341.85,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":24389.76,"10th_percentile":18698.71,"90th_percentile":31005.24},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14759.11,"10th_percentile":14759.11,"90th_percentile":14759.11,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":12345.12,"10th_percentile":12345.12,"90th_percentile":12345.12,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14526.5,"10th_percentile":14438.76,"90th_percentile":15299.18,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13064.27,"10th_percentile":13064.27,"90th_percentile":13064.27,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":32510.02,"10th_percentile":17263.48,"90th_percentile":33385.56,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"1 through 10","median_amount":29695.38,"10th_percentile":29695.38,"90th_percentile":29695.38,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14501.97,"10th_percentile":13472.49,"90th_percentile":15303.29,"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":"Youthcare","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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":13596.2,"10th_percentile":13596.2,"90th_percentile":13596.2,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18762.25,"10th_percentile":14707.28,"90th_percentile":20003.21,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":82206.63,"10th_percentile":82206.63,"90th_percentile":82206.63,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":81832.25,"10th_percentile":78686.08,"90th_percentile":113098.79,"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":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19465.95,"10th_percentile":19465.95,"90th_percentile":19473.58,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18864.8,"10th_percentile":18864.8,"90th_percentile":18864.8,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"12","median_amount":82701.22,"10th_percentile":69704.29,"90th_percentile":98680.59,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":33778.28,"10th_percentile":33778.28,"90th_percentile":33778.28},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"12","median_amount":19229.01,"10th_percentile":18758.47,"90th_percentile":19477.28,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18027.61,"10th_percentile":18027.61,"90th_percentile":18027.61,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":15157.81,"10th_percentile":15157.81,"90th_percentile":27293.0,"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":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":15460.97,"10th_percentile":15460.97,"90th_percentile":15460.97,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":43826.95,"10th_percentile":43826.95,"90th_percentile":43899.0,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19466.45,"10th_percentile":18180.42,"90th_percentile":20034.82,"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":"Youthcare","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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":35296.08,"10th_percentile":35296.08,"90th_percentile":35327.81,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":18682.34,"10th_percentile":18682.34,"90th_percentile":18682.34,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":33561.48,"10th_percentile":33561.48,"90th_percentile":33561.48,"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":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":85690.7,"10th_percentile":75540.27,"90th_percentile":132061.38,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":31078.36,"10th_percentile":31078.36,"90th_percentile":31078.36},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":28420.53,"10th_percentile":28420.53,"90th_percentile":28420.53,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":35118.32,"10th_percentile":34755.72,"90th_percentile":35335.6,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":79504.75,"10th_percentile":79504.75,"90th_percentile":79504.75,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":35325.06,"10th_percentile":35325.06,"90th_percentile":35325.06,"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":"Youthcare","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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":42481.13,"10th_percentile":42481.13,"90th_percentile":42481.13,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":15820.45,"10th_percentile":15820.45,"90th_percentile":15820.45},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":60.69,"10th_percentile":60.69,"90th_percentile":60.69,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Dental And Oral Diseases With Cc","code_information":[{"code":"158","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8748.67,"maximum":16403.26,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12459.74},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8748.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8748.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12128.76},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":12506.35},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13127.6},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8748.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8748.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":14269.13},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8748.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8748.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8748.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8748.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8748.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8748.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8748.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16403.26},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14983.11},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8748.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9968.86,"10th_percentile":9968.86,"90th_percentile":9968.86,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":161.51,"10th_percentile":161.51,"90th_percentile":161.51,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":3425.34,"10th_percentile":3425.34,"90th_percentile":3425.34,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7561.85,"10th_percentile":7561.85,"90th_percentile":7561.85,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":54519.13,"10th_percentile":54519.13,"90th_percentile":54519.13,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7513.39,"10th_percentile":7513.39,"90th_percentile":7513.39,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":2684.06,"10th_percentile":2684.06,"90th_percentile":4643.79,"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":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Dental And Oral Diseases With Mcc","code_information":[{"code":"157","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16041.07,"maximum":28557.89,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21692.28},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16041.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16041.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21116.04},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":21773.41},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22855.01},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16041.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16041.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":24842.4},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16041.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16041.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16041.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16041.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16041.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16041.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16041.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28557.89},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26085.42},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16041.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":43.0,"10th_percentile":43.0,"90th_percentile":43.0,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":28559.64,"10th_percentile":28559.64,"90th_percentile":28559.64,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/Mcc","code_information":[{"code":"156","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6772.41,"maximum":11727.33,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8907.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6772.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6772.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8671.32},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":8941.27},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9385.43},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6772.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6772.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10201.56},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6772.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6772.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6772.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6772.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6772.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6772.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6772.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11727.33},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10712.0},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6772.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":195.6,"10th_percentile":195.6,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12909.32,"10th_percentile":12909.32,"90th_percentile":12909.32,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5852.38,"10th_percentile":5852.38,"90th_percentile":5852.38,"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":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":25449.79,"10th_percentile":25449.79,"90th_percentile":25449.79,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":4296.28,"10th_percentile":4296.28,"90th_percentile":4296.28,"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":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7593.13,"10th_percentile":7593.13,"90th_percentile":7593.13,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":17317.26,"10th_percentile":17317.26,"90th_percentile":17317.26,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":5272.53,"10th_percentile":5272.53,"90th_percentile":5272.53,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6425.46,"10th_percentile":6425.46,"90th_percentile":6425.46,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20804.45,"10th_percentile":20804.45,"90th_percentile":20804.45,"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":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":6149.71,"10th_percentile":6149.71,"90th_percentile":6149.71,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9764.17,"10th_percentile":9764.17,"90th_percentile":9764.17,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":7198.02,"maximum":12412.76,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9428.6},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7198.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7198.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9178.14},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":9463.87},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9933.99},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7198.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7198.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10797.81},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7198.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7198.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7198.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7198.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7198.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7198.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7198.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12412.76},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11338.09},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7198.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6081.14,"10th_percentile":6081.14,"90th_percentile":6081.14,"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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":714.41,"10th_percentile":714.41,"90th_percentile":714.41,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1944.98,"10th_percentile":1944.98,"90th_percentile":1944.98,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":42399.95,"10th_percentile":42399.95,"90th_percentile":42399.95,"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":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22192.54,"10th_percentile":22192.54,"90th_percentile":22192.54,"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":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":24976.39,"10th_percentile":10206.99,"90th_percentile":42334.05,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5811.23,"10th_percentile":5811.23,"90th_percentile":5871.2,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":3454.54,"10th_percentile":3454.54,"90th_percentile":4333.35,"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":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":3633.97,"10th_percentile":3633.97,"90th_percentile":3633.97,"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":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":10299.96,"10th_percentile":10299.96,"90th_percentile":12412.76,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6216.04,"10th_percentile":6216.04,"90th_percentile":6216.04,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":11210.2,"maximum":19790.3,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15032.51},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11210.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11210.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14633.18},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":15088.73},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15838.27},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11210.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11210.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":17215.51},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11210.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11210.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11210.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11210.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11210.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11210.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11210.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19790.3},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18076.91},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11210.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4523.05,"10th_percentile":4523.05,"90th_percentile":4523.05,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":6458.14,"10th_percentile":6458.14,"90th_percentile":6458.14,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8641.38,"10th_percentile":8641.38,"90th_percentile":8641.38,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":4493.38,"10th_percentile":4493.38,"90th_percentile":4493.38,"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":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Epistaxis Without Mcc","code_information":[{"code":"151","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7160.07,"maximum":13220.28,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10041.98},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7160.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7160.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9775.23},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":10079.54},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10580.25},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7160.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7160.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11500.27},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7160.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7160.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7160.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7160.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7160.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7160.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7160.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13220.28},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12075.7},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7160.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":17542.38,"10th_percentile":17542.38,"90th_percentile":17542.38,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":12606.73,"10th_percentile":12606.73,"90th_percentile":12606.73,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Epistaxis With Mcc","code_information":[{"code":"150","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12559.34,"maximum":24105.21,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18310.06},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12559.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12559.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17823.67},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":18378.54},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19291.5},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12559.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12559.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":20969.03},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12559.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12559.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12559.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12559.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12559.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12559.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12559.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24105.21},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22018.24},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12559.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Dysequilibrium","code_information":[{"code":"149","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7319.11,"maximum":13037.15,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9902.88},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7319.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7319.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9639.82},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":9939.92},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10433.69},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7319.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7319.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11340.97},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7319.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7319.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7319.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7319.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7319.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7319.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7319.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13037.15},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11908.42},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7319.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9291.3,"10th_percentile":9291.3,"90th_percentile":9291.3,"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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6053.68,"10th_percentile":6053.68,"90th_percentile":6053.68,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22133.56,"10th_percentile":22133.56,"90th_percentile":22133.56,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":40826.05,"10th_percentile":40826.05,"90th_percentile":40826.05,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":13037.15,"10th_percentile":13037.15,"90th_percentile":13037.15,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5182.53,"10th_percentile":5182.53,"90th_percentile":5182.53,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ear, Nose, Mouth And Throat Malignancy Without Cc/Mcc","code_information":[{"code":"148","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7730.27,"maximum":13965.01,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10607.67},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7730.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7730.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10325.89},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":10647.35},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11176.26},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7730.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7730.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":12148.11},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7730.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7730.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7730.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7730.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7730.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7730.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7730.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13965.01},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12755.95},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7730.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":5173.27,"10th_percentile":5173.27,"90th_percentile":5173.27,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ear, Nose, Mouth And Throat Malignancy With Cc","code_information":[{"code":"147","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12017.15,"maximum":21708.81,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16489.79},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12017.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12017.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16051.75},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":16551.46},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17373.66},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12017.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12017.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":18884.41},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12017.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12017.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12017.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12017.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12017.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12017.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12017.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21708.81},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19829.32},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12017.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":7830.44,"10th_percentile":7830.44,"90th_percentile":7830.44,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8934.65,"10th_percentile":8934.65,"90th_percentile":8934.65,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9819.55,"10th_percentile":9819.55,"90th_percentile":9819.55,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ear, Nose, Mouth And Throat Malignancy With Mcc","code_information":[{"code":"146","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19661.07,"maximum":40007.91,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30389.59},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19661.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19661.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29582.32},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":30503.25},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32018.51},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19661.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19661.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":34802.73},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19661.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19661.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19661.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19661.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19661.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19661.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19661.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40007.91},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36544.12},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19661.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":7579.86,"10th_percentile":7579.86,"90th_percentile":7579.86,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":8045.55,"10th_percentile":8045.55,"90th_percentile":8045.55,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat O.R. Procedures Without Cc/Mcc","code_information":[{"code":"145","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11391.83,"maximum":20662.35,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15694.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11391.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11391.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15277.99},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":15753.61},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16536.17},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11391.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11391.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":17974.1},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11391.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11391.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11391.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11391.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11391.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11391.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11391.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20662.35},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18873.46},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11391.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":42435.54,"10th_percentile":42435.54,"90th_percentile":42435.54,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":3692.2,"10th_percentile":3692.2,"90th_percentile":3692.2},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat O.R. Procedures With Cc","code_information":[{"code":"144","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16186.56,"maximum":30636.86,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23271.44},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16186.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16186.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22653.25},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":23358.48},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24518.82},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16186.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16186.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":26650.89},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16186.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16186.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16186.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16186.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16186.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16186.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16186.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30636.86},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27984.39},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16186.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":16791.49,"10th_percentile":16791.49,"90th_percentile":16791.49},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13912.81,"10th_percentile":13912.81,"90th_percentile":13912.81,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":30223.51,"10th_percentile":30223.51,"90th_percentile":30223.51,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat O.R. Procedures With Mcc","code_information":[{"code":"143","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":34383.22,"maximum":57584.95,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43740.92},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34383.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34383.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":42578.99},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":43904.52},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":46085.49},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34383.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34383.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":50092.93},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34383.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34383.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34383.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34383.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34383.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34383.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34383.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57584.95},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":52599.38},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34383.22,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":9553.77,"10th_percentile":9553.77,"90th_percentile":9553.77,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head And Neck Procedures Without Cc/Mcc","code_information":[{"code":"142","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14953.09,"maximum":27422.48,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20829.83},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14953.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14953.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20276.51},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":20907.74},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21946.34},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14953.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14953.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":23854.72},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14953.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14953.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14953.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14953.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14953.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14953.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14953.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27422.48},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25048.31},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14953.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10921.16,"10th_percentile":10921.16,"90th_percentile":10921.16,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":124116.42,"10th_percentile":124116.42,"90th_percentile":124116.42,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":77967.65,"10th_percentile":77967.65,"90th_percentile":90549.62,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head And Neck Procedures With Cc","code_information":[{"code":"141","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20236.69,"maximum":37468.5,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28460.68},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20236.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20236.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27704.65},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":28567.13},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29986.21},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20236.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20236.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":32593.71},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20236.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20236.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20236.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20236.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20236.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20236.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20236.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37468.5},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34224.57},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20236.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":106717.02,"10th_percentile":106717.02,"90th_percentile":106717.02,"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":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15378.0,"10th_percentile":15378.0,"90th_percentile":15378.0,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":37471.99,"10th_percentile":37471.99,"90th_percentile":37471.99,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head And Neck Procedures With Mcc","code_information":[{"code":"140","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":39070.41,"maximum":73757.99,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56025.79},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39070.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39070.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":54537.52},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":56235.34},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":59028.85},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39070.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39070.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":64161.8},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39070.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39070.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39070.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39070.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39070.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39070.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39070.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":73757.99},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":67372.2},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39070.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Salivary Gland Procedures","code_information":[{"code":"139","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11693.65,"maximum":23944.75,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18188.18},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11693.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11693.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17705.03},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":18256.21},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19163.09},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11693.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11693.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":20829.45},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11693.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11693.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11693.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11693.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11693.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11693.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11693.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23944.75},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21871.67},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11693.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mouth Procedures Without Cc/Mcc","code_information":[{"code":"138","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8535.41,"maximum":14188.25,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10777.25},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8535.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8535.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10490.96},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":10817.56},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11354.92},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8535.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8535.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":12342.31},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8535.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8535.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8535.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8535.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8535.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8535.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8535.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14188.25},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12959.87},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8535.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mouth Procedures With Cc/Mcc","code_information":[{"code":"137","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14020.53,"maximum":24391.24,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18527.33},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14020.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14020.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18035.17},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":18596.62},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19520.42},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14020.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14020.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":21217.85},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14020.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14020.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14020.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14020.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14020.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14020.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14020.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24391.24},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22279.5},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14020.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":474.09,"10th_percentile":474.09,"90th_percentile":474.09,"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":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fractures Of Hip And Pelvis Without Mcc","code_information":[{"code":"536","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7825.15,"maximum":14142.91,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10742.8},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7825.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7825.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10457.43},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":10782.98},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11318.63},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7825.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7825.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":12302.86},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7825.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7825.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7825.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7825.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7825.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7825.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7825.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14142.91},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12918.45},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7825.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6525.0,"10th_percentile":6162.66,"90th_percentile":6751.82,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":46666.29,"10th_percentile":46666.29,"90th_percentile":46666.29,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":3875.46,"10th_percentile":3875.46,"90th_percentile":3875.46,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5954.84,"10th_percentile":5954.84,"90th_percentile":5954.84,"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":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":35557.95,"10th_percentile":35557.95,"90th_percentile":35557.95,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6540.64,"10th_percentile":6540.64,"90th_percentile":6540.64,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":14142.91,"10th_percentile":14142.91,"90th_percentile":14142.91,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5545.04,"10th_percentile":209.37,"90th_percentile":6751.82,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":9150.8,"maximum":16026.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12173.59},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9150.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9150.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11850.21},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":12219.12},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12826.11},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9150.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9150.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":13941.42},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9150.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9150.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9150.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9150.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9150.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9150.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9150.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16026.53},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14639.0},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9150.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1494.24,"10th_percentile":1494.24,"90th_percentile":1494.24,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/Mcc","code_information":[{"code":"538","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7036.27,"maximum":11711.63,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8896.03},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7036.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7036.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8659.72},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":8929.3},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9372.87},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7036.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7036.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10187.9},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7036.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7036.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7036.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7036.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7036.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7036.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7036.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11711.63},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10697.67},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7036.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Osteomyelitis With Mcc","code_information":[{"code":"539","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18326.39,"maximum":35277.91,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26796.73},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18326.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18326.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26084.9},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":26896.95},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28233.07},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18326.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18326.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":30688.12},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18326.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18326.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18326.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18326.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18326.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18326.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18326.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35277.91},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32223.63},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18326.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":183.81,"10th_percentile":183.81,"90th_percentile":183.81,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15723.76,"10th_percentile":15723.76,"90th_percentile":15723.76,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":34006.19,"10th_percentile":34006.19,"90th_percentile":34006.19,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13900.96,"10th_percentile":13900.96,"90th_percentile":13900.96,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Osteomyelitis With Cc","code_information":[{"code":"540","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12241.25,"maximum":22575.63,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17148.21},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12241.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12241.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16692.69},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":17212.35},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18067.38},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12241.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12241.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":19638.46},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12241.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12241.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12241.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12241.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12241.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12241.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12241.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22575.63},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20621.09},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12241.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10213.1,"10th_percentile":10213.1,"90th_percentile":10213.1,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":49357.08,"10th_percentile":49357.08,"90th_percentile":49357.08,"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":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":20922.05,"10th_percentile":20922.05,"90th_percentile":20922.05,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10927.25,"10th_percentile":10927.25,"90th_percentile":10927.25,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":22570.4,"10th_percentile":22570.4,"90th_percentile":22570.4,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Osteomyelitis Without Cc/Mcc","code_information":[{"code":"541","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7642.61,"maximum":15257.39,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11589.35},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7642.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7642.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11281.49},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11632.7},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12210.55},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7642.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7642.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":13272.34},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7642.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7642.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7642.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7642.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7642.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7642.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7642.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15257.39},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13936.44},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7642.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4963.57,"10th_percentile":4963.57,"90th_percentile":4963.57,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":19599.23,"10th_percentile":19599.23,"90th_percentile":19599.23,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Mcc","code_information":[{"code":"542","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16490.18,"maximum":32525.72,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24706.2},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16490.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16490.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24049.9},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":24798.6},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26030.48},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16490.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16490.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":28294.0},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16490.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16490.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16490.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16490.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16490.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16490.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16490.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32525.72},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29709.72},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16490.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14523.14,"10th_percentile":14523.14,"90th_percentile":14523.14,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":7145.27,"10th_percentile":7145.27,"90th_percentile":7145.27,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14533.88,"10th_percentile":14533.88,"90th_percentile":14533.88,"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":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":31987.62,"10th_percentile":31987.62,"90th_percentile":31987.62,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12452.28,"10th_percentile":12452.28,"90th_percentile":12452.28,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14305.54,"10th_percentile":14305.54,"90th_percentile":14305.54,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":9952.26,"10th_percentile":9952.26,"90th_percentile":9952.26,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8209.57,"10th_percentile":8209.57,"90th_percentile":14549.79,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc","code_information":[{"code":"543","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9816.78,"maximum":18501.41,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14053.48},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9816.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9816.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13680.16},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":14106.04},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14806.76},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9816.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9816.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":16094.31},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9816.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9816.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9816.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9816.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9816.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9816.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9816.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18501.41},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16899.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9816.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13454.8,"10th_percentile":13454.8,"90th_percentile":13454.8,"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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":7467.55,"10th_percentile":7467.55,"90th_percentile":7467.55,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6360.71,"10th_percentile":6118.01,"90th_percentile":7278.37,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":28235.32,"10th_percentile":28235.32,"90th_percentile":28235.32,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":53915.85,"10th_percentile":53915.85,"90th_percentile":63332.17,"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":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":7165.5,"10th_percentile":7165.5,"90th_percentile":7165.5,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8418.71,"10th_percentile":8418.71,"90th_percentile":8426.01,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8173.23,"10th_percentile":8173.23,"90th_percentile":8173.23,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":47728.61,"10th_percentile":22132.11,"90th_percentile":69461.27,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2996.09,"10th_percentile":2996.09,"90th_percentile":2996.09,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":7887.18,"10th_percentile":7887.18,"90th_percentile":7887.18,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8442.31,"10th_percentile":8442.31,"90th_percentile":8442.31,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8545.35,"10th_percentile":8545.35,"90th_percentile":8545.35,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":5718.31,"10th_percentile":5718.31,"90th_percentile":5718.31,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7928.71,"10th_percentile":6595.91,"90th_percentile":8418.71,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/Mcc","code_information":[{"code":"544","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7346.22,"maximum":13180.16,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10011.51},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7346.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7346.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9745.57},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":10048.96},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10548.14},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7346.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7346.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11465.37},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7346.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7346.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7346.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7346.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7346.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7346.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7346.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13180.16},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12039.06},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7346.22,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4519.84,"10th_percentile":4519.84,"90th_percentile":4519.84,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Connective Tissue Disorders With Mcc","code_information":[{"code":"545","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22953.04,"maximum":44068.17,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33473.72},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22953.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22953.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32584.53},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":33598.92},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35267.96},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22953.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22953.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":38334.74},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22953.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22953.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22953.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22953.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22953.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22953.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22953.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44068.17},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40252.86},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22953.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":47983.14,"10th_percentile":47983.14,"90th_percentile":47983.14,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":21331.15,"10th_percentile":21331.15,"90th_percentile":21331.15,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":22150.27,"10th_percentile":22150.27,"90th_percentile":22150.27},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18890.86,"10th_percentile":18890.86,"90th_percentile":18890.86,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17974.85,"10th_percentile":16898.76,"90th_percentile":19539.14,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Connective Tissue Disorders With Cc","code_information":[{"code":"546","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10949.95,"maximum":20191.45,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15337.21},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10949.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10949.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14929.79},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":15394.57},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16159.3},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10949.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10949.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":17564.46},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10949.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10949.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10949.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10949.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10949.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10949.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10949.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20191.45},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18443.32},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10949.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":95267.9,"10th_percentile":95267.9,"90th_percentile":95267.9,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":28064.78,"10th_percentile":28064.78,"90th_percentile":28064.78,"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":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":68964.85,"10th_percentile":52377.94,"90th_percentile":97744.48,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9177.35,"10th_percentile":9177.35,"90th_percentile":9177.35,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":20191.45,"10th_percentile":20191.45,"90th_percentile":20191.45,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":8083.59,"maximum":13014.47,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9885.66},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8083.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8083.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9623.05},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":9922.63},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10415.54},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8083.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8083.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11321.24},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8083.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8083.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8083.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8083.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8083.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8083.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8083.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13014.47},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11887.71},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8083.59,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10958.73,"10th_percentile":10958.73,"90th_percentile":10958.73,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":34825.04,"10th_percentile":34825.04,"90th_percentile":34825.04,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":35182.44,"10th_percentile":35182.44,"90th_percentile":229829.58,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":11667.33,"10th_percentile":11667.33,"90th_percentile":11667.33,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septic Arthritis With Mcc","code_information":[{"code":"548","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17975.77,"maximum":35134.89,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26688.1},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17975.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17975.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25979.15},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":26787.91},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28118.61},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17975.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17975.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":30563.71},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17975.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17975.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17975.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17975.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17975.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17975.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17975.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35134.89},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32093.0},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17975.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":13060.65,"10th_percentile":13060.65,"90th_percentile":13060.65,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":55384.69,"10th_percentile":55384.69,"90th_percentile":55384.69,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septic Arthritis With Cc","code_information":[{"code":"549","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11436.11,"maximum":21016.41,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15963.84},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11436.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11436.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15539.78},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":16023.55},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16819.52},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11436.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11436.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":18282.09},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11436.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11436.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11436.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11436.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11436.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11436.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11436.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21016.41},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19196.86},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11436.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":42126.77,"10th_percentile":42126.77,"90th_percentile":42126.77,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":9255.28,"10th_percentile":9255.28,"90th_percentile":9255.28},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":7558.15,"10th_percentile":7558.15,"90th_percentile":7558.15,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septic Arthritis Without Cc/Mcc","code_information":[{"code":"550","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8426.07,"maximum":15035.89,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11421.1},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8426.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8426.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11117.71},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11463.82},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12033.29},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8426.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8426.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":13079.66},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8426.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8426.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8426.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8426.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8426.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8426.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8426.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15035.89},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13734.12},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8426.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":32551.24,"10th_percentile":32551.24,"90th_percentile":32551.24,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Medical Back Problems With Mcc","code_information":[{"code":"551","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15673.29,"maximum":29759.58,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22605.06},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15673.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15673.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22004.58},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":22689.61},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23816.72},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15673.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15673.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":25887.74},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15673.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15673.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15673.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15673.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15673.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15673.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15673.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29759.58},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27183.07},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15673.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13948.48,"10th_percentile":13948.48,"90th_percentile":13948.48,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13314.84,"10th_percentile":13314.84,"90th_percentile":13314.84,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":53130.75,"10th_percentile":53130.75,"90th_percentile":53130.75,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11632.93,"10th_percentile":11632.93,"90th_percentile":11632.93,"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":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11819.94,"10th_percentile":11819.94,"90th_percentile":11819.94,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11008.54,"10th_percentile":11008.54,"90th_percentile":11008.54,"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":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":12363.55,"10th_percentile":12363.55,"90th_percentile":12363.55,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11490.87,"10th_percentile":11490.87,"90th_percentile":11634.24,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Medical Back Problems Without Mcc","code_information":[{"code":"552","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9214.05,"maximum":16809.64,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12768.42},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9214.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9214.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12429.24},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":12816.18},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13452.83},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9214.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9214.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":14622.64},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9214.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9214.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9214.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9214.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9214.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9214.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9214.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16809.64},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15354.3},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9214.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12733.42,"10th_percentile":11812.25,"90th_percentile":14139.07,"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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":4771.27,"10th_percentile":4397.07,"90th_percentile":7410.61,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"15","median_amount":7694.83,"10th_percentile":5880.46,"90th_percentile":7938.46,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5503.0,"10th_percentile":5503.0,"90th_percentile":5503.0,"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":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":22873.7,"10th_percentile":22777.42,"90th_percentile":72948.26,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26337.88,"10th_percentile":17166.85,"90th_percentile":47933.3,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":4064.01,"10th_percentile":3989.03,"90th_percentile":8072.14,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7707.83,"10th_percentile":7683.2,"90th_percentile":7861.58,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7458.57,"10th_percentile":7458.57,"90th_percentile":7458.57,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"17","median_amount":34503.11,"10th_percentile":18551.67,"90th_percentile":61982.02,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":8743.4,"10th_percentile":8743.4,"90th_percentile":8743.4},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7635.2,"10th_percentile":7635.2,"90th_percentile":7938.46,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":7940.47,"10th_percentile":7940.47,"90th_percentile":7940.47,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"18","median_amount":6782.06,"10th_percentile":1070.97,"90th_percentile":7702.7,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6130.39,"10th_percentile":6130.39,"90th_percentile":6130.39,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":5049.46,"10th_percentile":1049.45,"90th_percentile":6384.21,"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":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":40.19,"10th_percentile":40.19,"90th_percentile":40.19,"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 Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":8198.83,"10th_percentile":8198.83,"90th_percentile":8198.83,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":16766.03,"10th_percentile":16766.03,"90th_percentile":16766.03,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6209.02,"10th_percentile":194.67,"90th_percentile":7369.24,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bone Diseases And Arthropathies With Mcc","code_information":[{"code":"553","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12241.25,"maximum":22783.18,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17305.86},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12241.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12241.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16846.15},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":17370.59},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18233.48},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12241.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12241.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":19819.0},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12241.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12241.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12241.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12241.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12241.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12241.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12241.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22783.18},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20810.67},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12241.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":10194.23,"10th_percentile":10194.23,"90th_percentile":10194.23,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":11745.41,"10th_percentile":11745.41,"90th_percentile":11745.41,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4587.74,"10th_percentile":4587.74,"90th_percentile":4587.74,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8995.56,"10th_percentile":8995.56,"90th_percentile":8995.56,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8437.77,"10th_percentile":8437.77,"90th_percentile":8437.77,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bone Diseases And Arthropathies Without Mcc","code_information":[{"code":"554","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8028.47,"maximum":14556.26,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11056.78},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8028.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8028.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10763.07},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11098.14},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11649.44},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8028.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8028.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":12662.43},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8028.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8028.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8028.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8028.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8028.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8028.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8028.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14556.26},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13296.01},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8028.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7746.86,"10th_percentile":7746.86,"90th_percentile":7746.86,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":1539.91,"10th_percentile":1539.91,"90th_percentile":1539.91,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6410.54,"10th_percentile":6410.54,"90th_percentile":6410.54,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":19538.94,"10th_percentile":19538.94,"90th_percentile":19538.94,"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":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":36135.89,"10th_percentile":36135.89,"90th_percentile":69141.07,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":4285.15,"10th_percentile":4285.15,"90th_percentile":4285.15,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":22806.91,"10th_percentile":22806.91,"90th_percentile":47656.93,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6710.29,"10th_percentile":6710.29,"90th_percentile":6710.29,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":3672.94,"10th_percentile":3672.94,"90th_percentile":3672.94,"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":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4886.99,"10th_percentile":285.37,"90th_percentile":6710.39,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Signs And Symptoms Of Musculoskeletal System And Connective Tissue With Mcc","code_information":[{"code":"555","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12471.68,"maximum":23484.31,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17838.43},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12471.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12471.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17364.57},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":17905.15},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18794.6},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12471.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12471.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":20428.91},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12471.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12471.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12471.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12471.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12471.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12471.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12471.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23484.31},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21451.09},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12471.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20423.59,"10th_percentile":20423.59,"90th_percentile":20423.59,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10345.89,"10th_percentile":10345.89,"90th_percentile":10345.89,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":23486.05,"10th_percentile":23486.05,"90th_percentile":23486.05,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatectomy With Mcc","code_information":[{"code":"665","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28731.83,"maximum":59881.93,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45485.68},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28731.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28731.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44277.4},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":45655.81},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":47923.77},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28731.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28731.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":52091.06},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28731.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28731.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28731.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28731.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28731.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28731.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28731.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59881.93},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":54697.5},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28731.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24615.79,"10th_percentile":24615.79,"90th_percentile":24615.79,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12880.82,"10th_percentile":12880.82,"90th_percentile":12880.82,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":36028.13,"10th_percentile":36028.13,"90th_percentile":36028.13,"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":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":47236.52,"10th_percentile":47236.52,"90th_percentile":47236.52,"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":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":82937.73,"10th_percentile":82937.73,"90th_percentile":82937.73,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatectomy Without Cc/Mcc","code_information":[{"code":"667","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10523.43,"maximum":17924.12,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13614.97},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10523.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10523.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13253.3},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":13665.89},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14344.75},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10523.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10523.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":15592.12},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10523.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10523.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10523.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10523.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10523.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10523.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10523.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17924.12},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16372.29},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10523.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":56620.08,"10th_percentile":56620.08,"90th_percentile":56620.08,"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":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":30643.55,"10th_percentile":30643.55,"90th_percentile":30643.55,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transurethral Procedures With Mcc","code_information":[{"code":"668","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26913.71,"maximum":50859.7,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38632.49},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26913.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26913.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37606.26},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":38776.99},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40703.24},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26913.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26913.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":44242.66},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26913.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26913.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26913.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26913.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26913.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26913.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26913.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50859.7},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":46456.39},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26913.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24038.34,"10th_percentile":24038.34,"90th_percentile":24038.34,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":86011.08,"10th_percentile":86011.08,"90th_percentile":86011.08,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transurethral Procedures With Cc","code_information":[{"code":"669","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14551.87,"maximum":26989.95,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20501.28},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14551.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14551.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19956.68},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":20577.96},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21600.18},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14551.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14551.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":23478.45},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14551.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14551.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14551.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14551.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14551.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14551.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14551.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26989.95},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24653.22},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14551.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7628.45,"10th_percentile":7628.45,"90th_percentile":7628.45,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10462.05,"10th_percentile":10462.05,"90th_percentile":10462.05,"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":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12503.77,"10th_percentile":12503.77,"90th_percentile":12503.77,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":10856.44,"10th_percentile":10856.44,"90th_percentile":10856.44,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transurethral Procedures Without Cc/Mcc","code_information":[{"code":"670","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9358.63,"maximum":16666.62,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12659.79},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9358.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9358.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12323.49},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":12707.14},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13338.37},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9358.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9358.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":14498.23},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9358.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9358.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9358.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9358.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9358.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9358.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9358.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16666.62},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15223.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9358.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7511.45,"10th_percentile":7511.45,"90th_percentile":7511.45,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22191.71,"10th_percentile":22191.71,"90th_percentile":22191.71,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7245.68,"10th_percentile":7245.68,"90th_percentile":7245.68,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urethral Procedures With Cc/Mcc","code_information":[{"code":"671","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16747.72,"maximum":30061.31,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22834.25},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16747.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16747.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22227.68},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":22919.66},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24058.2},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16747.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16747.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":26150.22},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16747.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16747.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16747.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16747.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16747.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16747.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16747.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30061.31},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27458.67},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16747.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13228.39,"10th_percentile":13228.39,"90th_percentile":13228.39,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urethral Procedures Without Cc/Mcc","code_information":[{"code":"672","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10282.16,"maximum":19085.69,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14497.29},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10282.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10282.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14112.18},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":14551.51},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15274.36},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10282.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10282.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":16602.57},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10282.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10282.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10282.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10282.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10282.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10282.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10282.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19085.69},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17433.29},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10282.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Procedures With Mcc","code_information":[{"code":"673","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":38494.79,"maximum":73077.79,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55509.12},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38494.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38494.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":54034.58},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":55716.73},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":58484.48},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38494.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38494.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":63570.09},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38494.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38494.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38494.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38494.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38494.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38494.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38494.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":73077.79},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":66750.89},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38494.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":37475.55,"10th_percentile":37475.55,"90th_percentile":37475.55,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":101681.44,"10th_percentile":101681.44,"90th_percentile":101681.44,"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":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":31179.74,"10th_percentile":31179.74,"90th_percentile":31179.74,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":191472.7,"10th_percentile":191472.7,"90th_percentile":191472.7,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":38951.05,"10th_percentile":38951.05,"90th_percentile":38951.05,"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":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":32144.06,"10th_percentile":32144.06,"90th_percentile":32146.57,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":29418.66,"10th_percentile":29418.66,"90th_percentile":29418.66,"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":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":32955.04,"10th_percentile":32955.04,"90th_percentile":32955.04,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":21659.92,"maximum":40259.06,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30580.36},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21659.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21659.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29768.02},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":30694.73},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32219.51},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21659.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21659.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":35021.2},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21659.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21659.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21659.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21659.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21659.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21659.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21659.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40259.06},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36773.53},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21659.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30581.68,"10th_percentile":30581.68,"90th_percentile":30581.68,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":6048.93,"10th_percentile":6048.93,"90th_percentile":6048.93,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17884.06,"10th_percentile":17884.06,"90th_percentile":17884.06,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":41326.25,"10th_percentile":41326.25,"90th_percentile":41326.25,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":73510.49,"10th_percentile":73510.49,"90th_percentile":73510.49,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":90012.74,"10th_percentile":90012.74,"90th_percentile":90012.74,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16883.26,"10th_percentile":16883.26,"90th_percentile":16883.26,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":16342.58,"10th_percentile":16342.58,"90th_percentile":16342.58,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17882.67,"10th_percentile":17868.16,"90th_percentile":75652.67,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18066.55,"10th_percentile":18066.55,"90th_percentile":18066.55,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":6645.45,"10th_percentile":6645.45,"90th_percentile":6645.45,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17314.06,"10th_percentile":17314.06,"90th_percentile":17882.67,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":15359.73,"maximum":27298.65,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20735.77},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15359.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15359.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20184.94},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":20813.33},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21847.23},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15359.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15359.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":23747.0},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15359.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15359.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15359.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15359.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15359.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15359.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15359.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27298.65},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24935.2},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15359.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":18350.06,"10th_percentile":18350.06,"90th_percentile":18350.06,"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":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":13910.28,"maximum":26196.38,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19898.5},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13910.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13910.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19369.91},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":19972.92},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20965.08},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13910.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13910.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":22788.13},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13910.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13910.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13910.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13910.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13910.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13910.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13910.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26196.38},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23928.36},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13910.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12051.15,"10th_percentile":12051.15,"90th_percentile":12051.15,"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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8945.25,"10th_percentile":4430.74,"90th_percentile":11966.79,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11583.17,"10th_percentile":11583.17,"90th_percentile":11583.17,"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":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":197589.91,"10th_percentile":197589.91,"90th_percentile":197589.91,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":93429.59,"10th_percentile":85480.74,"90th_percentile":96255.63,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":6048.93,"10th_percentile":6048.93,"90th_percentile":6645.45,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11637.19,"10th_percentile":11637.19,"90th_percentile":11637.19,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11416.41,"10th_percentile":11416.41,"90th_percentile":11416.41,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":78553.32,"10th_percentile":44301.45,"90th_percentile":225896.97,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":26061.97,"10th_percentile":21395.23,"90th_percentile":42488.54},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":11031.19,"10th_percentile":7043.66,"90th_percentile":23031.56,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9671.95,"10th_percentile":9671.95,"90th_percentile":9671.95,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"13","median_amount":10602.54,"10th_percentile":5553.31,"90th_percentile":11384.59,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10291.54,"10th_percentile":10291.54,"90th_percentile":10291.54,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11759.12,"10th_percentile":11759.12,"90th_percentile":11759.12,"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":"[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":7524.26,"10th_percentile":7524.26,"90th_percentile":7524.26,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9935.39,"10th_percentile":9935.39,"90th_percentile":11659.86,"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 Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":4073.36,"10th_percentile":4073.36,"90th_percentile":4073.36,"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":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":25006.64,"10th_percentile":25006.64,"90th_percentile":25006.64,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"13","median_amount":10299.5,"10th_percentile":9573.15,"90th_percentile":11950.79,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":8441.44,"maximum":15503.3,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11776.15},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8441.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8441.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11463.33},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11820.19},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12407.36},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8441.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8441.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":13486.27},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8441.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8441.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8441.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8441.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8441.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8441.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8441.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15503.3},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14161.07},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8441.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11776.15,"10th_percentile":11476.15,"90th_percentile":32403.58,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":5259.39,"10th_percentile":5259.39,"90th_percentile":5259.39,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"18","median_amount":6662.62,"10th_percentile":446.48,"90th_percentile":7145.98,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5479.5,"10th_percentile":5479.5,"90th_percentile":5479.5,"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":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":81045.08,"10th_percentile":81045.08,"90th_percentile":81045.08,"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":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14584.0,"10th_percentile":8293.9,"90th_percentile":22564.56,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":4038.79,"10th_percentile":194.67,"90th_percentile":6645.45,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7133.87,"10th_percentile":6451.19,"90th_percentile":8043.69,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7060.53,"10th_percentile":7060.53,"90th_percentile":7060.53,"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":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"15","median_amount":25792.43,"10th_percentile":16115.61,"90th_percentile":56719.75,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":6199.79,"10th_percentile":6199.79,"90th_percentile":6199.79},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6606.67,"10th_percentile":6606.67,"90th_percentile":7116.89,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":3993.49,"10th_percentile":3993.49,"90th_percentile":3993.49,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"20","median_amount":7115.87,"10th_percentile":6303.66,"90th_percentile":7282.98,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5635.88,"10th_percentile":5635.88,"90th_percentile":5635.88,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":6645.45,"10th_percentile":4380.58,"90th_percentile":6892.66,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4947.71,"10th_percentile":4947.71,"90th_percentile":6303.66,"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":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":6778.36,"10th_percentile":6778.36,"90th_percentile":6778.36,"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":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":14844.64,"10th_percentile":13628.4,"90th_percentile":15503.3,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"1 through 10","median_amount":14161.07,"10th_percentile":14161.07,"90th_percentile":14161.07,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"16","median_amount":5455.57,"10th_percentile":282.87,"90th_percentile":7121.99,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":5951.9,"maximum":10595.41,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8048.16},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5951.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5951.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7834.37},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":8078.26},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8479.55},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5951.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5951.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":9216.9},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5951.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5951.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5951.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5951.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5951.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5951.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5951.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10595.41},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9678.08},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5951.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4399.4,"10th_percentile":4399.4,"90th_percentile":4399.4,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":899.3,"10th_percentile":899.3,"90th_percentile":899.3,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4838.12,"10th_percentile":4838.12,"90th_percentile":4838.12,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":28282.44,"10th_percentile":28282.44,"90th_percentile":35864.74,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":4258.02,"10th_percentile":4258.02,"90th_percentile":4258.02,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4725.43,"10th_percentile":4725.43,"90th_percentile":4725.43,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5085.12,"10th_percentile":5085.12,"90th_percentile":5085.12,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"1 through 10","median_amount":7257.38,"10th_percentile":7257.38,"90th_percentile":7257.38,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":3990.07,"10th_percentile":3990.07,"90th_percentile":3990.07,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Neoplasms With Mcc","code_information":[{"code":"686","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16826.34,"maximum":32886.75,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24980.43},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16826.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16826.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24316.85},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":25073.86},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26319.41},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16826.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16826.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":28608.06},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16826.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16826.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16826.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16826.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16826.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16826.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16826.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32886.75},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30039.49},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16826.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":9656.75,"10th_percentile":9656.75,"90th_percentile":9656.75,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":84586.65,"10th_percentile":84586.65,"90th_percentile":84586.65,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14008.9,"10th_percentile":14008.9,"90th_percentile":14008.9,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":10175.57,"10th_percentile":10175.57,"90th_percentile":10175.57,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14679.34,"10th_percentile":14679.34,"90th_percentile":14679.34,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Neoplasms With Cc","code_information":[{"code":"687","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9995.7,"maximum":18358.4,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13944.84},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9995.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9995.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13574.41},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":13997.0},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14692.31},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9995.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9995.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":15969.9},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9995.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9995.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9995.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9995.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9995.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9995.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9995.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18358.4},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16768.97},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9995.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":18758.87,"10th_percentile":18758.87,"90th_percentile":18758.87,"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":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8606.28,"10th_percentile":8606.28,"90th_percentile":8606.28,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":7397.23,"10th_percentile":7397.23,"90th_percentile":7397.23,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8449.49,"10th_percentile":8449.49,"90th_percentile":8449.49,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Neoplasms Without Cc/Mcc","code_information":[{"code":"688","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7668.82,"maximum":12630.77,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9594.2},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7668.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7668.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9339.34},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":9630.09},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10108.46},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7668.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7668.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10987.46},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7668.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7668.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7668.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7668.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7668.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7668.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7668.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12630.77},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11537.23},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7668.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Infections With Mcc","code_information":[{"code":"689","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11012.3,"maximum":20412.95,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15505.46},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11012.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11012.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15093.57},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":15563.45},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16336.57},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11012.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11012.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":17757.14},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11012.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11012.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11012.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11012.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11012.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11012.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11012.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20412.95},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18645.64},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11012.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13997.7,"10th_percentile":13997.7,"90th_percentile":13997.7,"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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":4259.12,"10th_percentile":3880.7,"90th_percentile":8992.78,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"13","median_amount":7973.38,"10th_percentile":3547.99,"90th_percentile":9474.82,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":78154.09,"10th_percentile":78154.09,"90th_percentile":78154.09,"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":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25500.0,"10th_percentile":25500.0,"90th_percentile":74288.07,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8267.38,"10th_percentile":765.96,"90th_percentile":10483.37,"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":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8977.77,"10th_percentile":8977.77,"90th_percentile":9191.27,"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":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":37016.51,"10th_percentile":19741.28,"90th_percentile":76237.38,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9287.58,"10th_percentile":9287.58,"90th_percentile":9287.58,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8346.39,"10th_percentile":8346.39,"90th_percentile":8346.39,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"19","median_amount":9098.46,"10th_percentile":5826.24,"90th_percentile":9288.65,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7713.08,"10th_percentile":7713.08,"90th_percentile":7713.08,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":5618.63,"10th_percentile":293.09,"90th_percentile":13594.04,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4599.06,"10th_percentile":4599.06,"90th_percentile":4599.06,"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 Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":10689.57,"10th_percentile":10689.57,"90th_percentile":10689.57,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"17","median_amount":8716.7,"10th_percentile":5558.57,"90th_percentile":9255.44,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":7842.32,"maximum":13998.15,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10632.84},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7842.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7842.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10350.39},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":10672.61},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11202.78},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7842.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7842.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":12176.93},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7842.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7842.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7842.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7842.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7842.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7842.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7842.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13998.15},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12786.22},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7842.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10632.84,"10th_percentile":4833.11,"90th_percentile":11926.02,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient 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":4132.2,"10th_percentile":314.73,"90th_percentile":5357.87,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"22","median_amount":6467.21,"10th_percentile":1536.14,"90th_percentile":6766.49,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6462.13,"10th_percentile":6462.13,"90th_percentile":6462.13,"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":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":26597.95,"10th_percentile":26597.95,"90th_percentile":26597.95,"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":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20467.98,"10th_percentile":17788.91,"90th_percentile":38944.54,"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":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":3966.03,"10th_percentile":3470.32,"90th_percentile":6879.76,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6377.64,"10th_percentile":5657.43,"90th_percentile":6766.49,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6563.49,"10th_percentile":6563.49,"90th_percentile":6563.49,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"25","median_amount":23991.15,"10th_percentile":14074.73,"90th_percentile":37521.63,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":3165.98,"10th_percentile":302.17,"90th_percentile":4259.12,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5827.13,"10th_percentile":5827.13,"90th_percentile":5827.13,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"25","median_amount":6467.7,"10th_percentile":1580.3,"90th_percentile":6772.89,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4893.65,"10th_percentile":4893.65,"90th_percentile":4893.65,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":3165.98,"10th_percentile":363.88,"90th_percentile":5786.04,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4307.89,"10th_percentile":4307.89,"90th_percentile":5325.54,"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":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":3979.51,"10th_percentile":321.02,"90th_percentile":4366.37,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":13998.15,"10th_percentile":7345.05,"90th_percentile":14118.49,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"1 through 10","median_amount":12786.22,"10th_percentile":12786.22,"90th_percentile":12786.22,"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":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"27","median_amount":6464.17,"10th_percentile":283.87,"90th_percentile":6495.0,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urinary Stones With Mcc","code_information":[{"code":"693","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12676.81,"maximum":25643.5,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19478.53},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12676.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12676.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18961.11},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":19551.39},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20522.61},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12676.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12676.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":22307.19},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12676.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12676.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12676.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12676.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12676.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12676.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12676.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25643.5},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23423.35},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12676.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":212.38,"10th_percentile":212.38,"90th_percentile":212.38,"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":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":160.37,"10th_percentile":160.37,"90th_percentile":160.37,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urinary Stones Without Mcc","code_information":[{"code":"694","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7591.11,"maximum":13628.4,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10351.99},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7591.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7591.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10077.0},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":10390.71},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10906.87},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7591.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7591.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11855.29},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7591.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7591.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7591.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7591.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7591.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7591.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7591.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13628.4},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12448.48},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7591.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":25902.28,"10th_percentile":25902.28,"90th_percentile":25902.28,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21413.6,"10th_percentile":21413.6,"90th_percentile":21413.6,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":5175.15,"10th_percentile":5175.15,"90th_percentile":5175.15,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":60466.55,"10th_percentile":60466.55,"90th_percentile":60466.55,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7357.65,"10th_percentile":7357.65,"90th_percentile":7357.65,"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":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5537.18,"10th_percentile":5537.18,"90th_percentile":6551.85,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":1145.11,"10th_percentile":1145.11,"90th_percentile":4159.58,"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":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":501.06,"10th_percentile":501.06,"90th_percentile":501.06,"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 Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5394.28,"10th_percentile":5394.28,"90th_percentile":5394.28,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Signs And Symptoms With Mcc","code_information":[{"code":"695","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10863.2,"maximum":19668.22,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14939.77},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10863.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10863.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14542.91},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":14995.65},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15740.56},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10863.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10863.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":17109.31},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10863.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10863.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10863.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10863.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10863.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10863.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10863.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19668.22},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17965.39},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10863.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":19869.72,"10th_percentile":19869.72,"90th_percentile":19869.72,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9347.45,"10th_percentile":9347.45,"90th_percentile":9347.45,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Signs And Symptoms Without Mcc","code_information":[{"code":"696","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6753.43,"maximum":12063.94,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9163.64},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6753.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6753.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8920.22},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":9197.92},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9654.82},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6753.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6753.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10494.38},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6753.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6753.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6753.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6753.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6753.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6753.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6753.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12063.94},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11019.47},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6753.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5832.28,"10th_percentile":5832.28,"90th_percentile":5832.28,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5635.08,"10th_percentile":5635.08,"90th_percentile":5775.83,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":71683.39,"10th_percentile":71683.39,"90th_percentile":71683.39,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14835.6,"10th_percentile":14835.6,"90th_percentile":14835.6,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":3285.53,"10th_percentile":3285.53,"90th_percentile":3285.53,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1327.95,"10th_percentile":1327.95,"90th_percentile":1327.95,"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":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":22550.71,"10th_percentile":22550.71,"90th_percentile":22550.71,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5641.29,"10th_percentile":5641.29,"90th_percentile":5645.87,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1005.23,"10th_percentile":1005.23,"90th_percentile":5627.66,"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":"Youthcare","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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Diagnoses With Mcc","code_information":[{"code":"698","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15477.2,"maximum":29316.58,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22268.56},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15477.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15477.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21677.02},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":22351.85},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23462.19},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15477.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15477.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":25502.38},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15477.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15477.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15477.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15477.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15477.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15477.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15477.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29316.58},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26778.42},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15477.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22268.56,"10th_percentile":22268.56,"90th_percentile":22268.56,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":7866.19,"10th_percentile":5560.91,"90th_percentile":24737.19,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13115.04,"10th_percentile":7631.9,"90th_percentile":13290.52,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":36552.01,"10th_percentile":36552.01,"90th_percentile":47131.77,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":53831.01,"10th_percentile":53831.01,"90th_percentile":62796.9,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":5915.4,"10th_percentile":5915.4,"90th_percentile":5915.4,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13146.61,"10th_percentile":12368.03,"90th_percentile":13270.17,"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":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12732.82,"10th_percentile":12732.82,"90th_percentile":12890.82,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":53890.91,"10th_percentile":30641.54,"90th_percentile":98158.89,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12086.03,"10th_percentile":12086.03,"90th_percentile":12097.6,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":5915.4,"10th_percentile":5915.4,"90th_percentile":10025.72,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11392.86,"10th_percentile":6787.27,"90th_percentile":13115.04,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13267.07,"10th_percentile":13267.07,"90th_percentile":13267.07,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11484.13,"10th_percentile":11484.13,"90th_percentile":11484.13,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":9114.68,"10th_percentile":6109.88,"90th_percentile":30088.21,"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":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10819.48,"10th_percentile":10819.48,"90th_percentile":10819.48,"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":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":17788.08,"10th_percentile":17788.08,"90th_percentile":17788.08,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13125.61,"10th_percentile":7850.41,"90th_percentile":24904.96,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Diagnoses With Cc","code_information":[{"code":"699","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9699.31,"maximum":17786.33,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13510.31},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9699.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9699.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13151.42},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":13560.84},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14234.48},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9699.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9699.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":15472.26},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9699.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9699.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9699.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9699.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9699.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9699.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9699.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17786.33},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16246.43},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9699.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":33550.76,"10th_percentile":33550.76,"90th_percentile":33550.76,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8115.17,"10th_percentile":8115.17,"90th_percentile":8115.17,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8133.79,"10th_percentile":8133.79,"90th_percentile":8133.79,"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":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":31092.67,"10th_percentile":31092.67,"90th_percentile":31092.67,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13563.32,"10th_percentile":13563.32,"90th_percentile":13563.32,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":6213.5,"10th_percentile":6213.5,"90th_percentile":6213.5,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8115.17,"10th_percentile":8115.17,"90th_percentile":8115.17,"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":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7871.72,"10th_percentile":7871.72,"90th_percentile":7871.72,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":40598.52,"10th_percentile":39707.84,"90th_percentile":87942.72,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7924.07,"10th_percentile":6175.92,"90th_percentile":8123.76,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8203.4,"10th_percentile":8203.4,"90th_percentile":8203.41,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":7107.41,"10th_percentile":1183.08,"90th_percentile":7879.59,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5918.93,"10th_percentile":5918.93,"90th_percentile":5918.93,"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":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7552.79,"10th_percentile":337.33,"90th_percentile":8147.66,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Diagnoses Without Cc/Mcc","code_information":[{"code":"700","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6761.56,"maximum":12105.8,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9195.44},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6761.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6761.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8951.17},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":9229.83},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9688.32},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6761.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6761.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10530.79},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6761.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6761.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6761.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6761.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6761.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6761.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6761.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12105.8},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11057.71},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6761.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":206.88,"10th_percentile":206.88,"90th_percentile":206.88,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":24843.55,"10th_percentile":24843.55,"90th_percentile":24843.55,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":29012.86,"10th_percentile":29012.86,"90th_percentile":29012.86,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5659.35,"10th_percentile":5659.35,"90th_percentile":5843.12,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Male Pelvic Procedures With Cc/Mcc","code_information":[{"code":"707","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18602.9,"maximum":33844.26,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25707.74},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18602.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18602.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25024.84},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":25803.9},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27085.71},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18602.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18602.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":29440.99},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18602.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18602.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18602.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18602.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18602.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18602.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18602.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33844.26},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30914.11},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18602.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":124948.15,"10th_percentile":124948.15,"90th_percentile":124948.15,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13948.95,"10th_percentile":13948.95,"90th_percentile":13948.95,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":42676.65,"10th_percentile":42676.65,"90th_percentile":42676.65,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Male Pelvic Procedures Without Cc/Mcc","code_information":[{"code":"708","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14391.02,"maximum":25854.54,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19638.84},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14391.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14391.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19117.15},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":19712.29},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20691.5},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14391.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14391.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":22490.77},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14391.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14391.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14391.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14391.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14391.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14391.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14391.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25854.54},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23616.11},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14391.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11622.43,"10th_percentile":11622.43,"90th_percentile":11622.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":45246.63,"10th_percentile":45246.63,"90th_percentile":45246.63,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11262.53,"10th_percentile":11262.53,"90th_percentile":11262.53,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":25270.54,"10th_percentile":25270.54,"90th_percentile":25270.54,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Penis Procedures With Cc/Mcc","code_information":[{"code":"709","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21556.01,"maximum":39189.93,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29768.26},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21556.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21556.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28977.49},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":29879.59},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31363.87},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21556.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21556.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":34091.17},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21556.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21556.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21556.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21556.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21556.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21556.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21556.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39189.93},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35796.96},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21556.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":9225.37,"10th_percentile":9225.37,"90th_percentile":9225.37,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Penis Procedures Without Cc/Mcc","code_information":[{"code":"710","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13189.18,"maximum":26184.17,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19889.22},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13189.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13189.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19360.88},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":19963.61},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20955.31},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13189.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13189.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":22777.51},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13189.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13189.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13189.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13189.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13189.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13189.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13189.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26184.17},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23917.21},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13189.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":7292.22,"10th_percentile":7292.22,"90th_percentile":7292.22,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":23061.61,"10th_percentile":23061.61,"90th_percentile":23061.61,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Testes Procedures With Cc/Mcc","code_information":[{"code":"711","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19357.44,"maximum":33322.77,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25311.63},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19357.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19357.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24639.25},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":25406.3},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26668.36},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19357.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19357.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":28987.36},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19357.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19357.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19357.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19357.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19357.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19357.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19357.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33322.77},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30437.77},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19357.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":130668.98,"10th_percentile":130668.98,"90th_percentile":130668.98,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13991.96,"10th_percentile":13991.96,"90th_percentile":13991.96,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":17284.59,"10th_percentile":17284.59,"90th_percentile":17284.59,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Testes Procedures Without Cc/Mcc","code_information":[{"code":"712","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10464.69,"maximum":18654.89,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14170.06},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10464.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10464.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13793.65},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":14223.06},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14929.59},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10464.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10464.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":16227.82},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10464.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10464.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10464.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10464.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10464.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10464.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10464.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18654.89},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17039.8},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10464.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":33193.93,"10th_percentile":33193.93,"90th_percentile":33193.93,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transurethral Prostatectomy With Cc/Mcc","code_information":[{"code":"713","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14112.7,"maximum":25217.94,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19155.28},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14112.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14112.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18646.44},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":19226.93},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20182.03},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14112.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14112.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":21936.99},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14112.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14112.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14112.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14112.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14112.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14112.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14112.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25217.94},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23034.63},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14112.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19156.61,"10th_percentile":19156.61,"90th_percentile":19156.61,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11345.68,"10th_percentile":11345.68,"90th_percentile":11345.68,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":73429.24,"10th_percentile":73429.24,"90th_percentile":73429.24,"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":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12124.65,"10th_percentile":12124.65,"90th_percentile":12124.65,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":66224.38,"10th_percentile":66224.38,"90th_percentile":66224.38,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"1 through 10","median_amount":23036.23,"10th_percentile":23036.23,"90th_percentile":23036.23,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14037.58,"10th_percentile":14037.58,"90th_percentile":14037.58,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transurethral Prostatectomy Without Cc/Mcc","code_information":[{"code":"714","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10082.45,"maximum":16387.56,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12447.82},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10082.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10082.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12117.16},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":12494.38},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13115.04},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10082.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10082.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":14255.48},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10082.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10082.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10082.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10082.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10082.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10082.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10082.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16387.56},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14968.77},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10082.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8527.33,"10th_percentile":8527.33,"90th_percentile":8527.33,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7511.02,"10th_percentile":7511.02,"90th_percentile":7511.02,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":5528.82,"10th_percentile":5528.82,"90th_percentile":5528.82,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System O.R. Procedures For Malignancy With Cc/Mcc","code_information":[{"code":"715","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20744.53,"maximum":39385.27,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29916.63},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20744.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20744.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29121.93},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":30028.53},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31520.2},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20744.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20744.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":34261.09},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20744.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20744.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20744.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20744.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20744.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20744.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20744.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39385.27},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35975.38},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20744.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17505.69,"10th_percentile":17505.69,"90th_percentile":17505.69,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/Mcc","code_information":[{"code":"716","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13819.92,"maximum":24752.27,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18801.56},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13819.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13819.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18302.12},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":18871.88},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19809.35},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13819.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13819.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":21531.9},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13819.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13819.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13819.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13819.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13819.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13819.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13819.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24752.27},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22609.28},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13819.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/Mcc","code_information":[{"code":"717","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17610.7,"maximum":32360.03,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24580.34},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17610.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17610.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23927.39},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":24672.27},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25897.88},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17610.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17610.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":28149.87},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17610.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17610.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17610.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17610.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17610.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17610.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17610.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32360.03},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29558.38},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17610.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12967.59,"10th_percentile":12967.59,"90th_percentile":12967.59,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/Mcc","code_information":[{"code":"718","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12664.16,"maximum":21483.82,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16318.89},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12664.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12664.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15885.39},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":16379.92},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17193.6},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12664.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12664.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":18688.7},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12664.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12664.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12664.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12664.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12664.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12664.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12664.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21483.82},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19623.81},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12664.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":2931.16,"10th_percentile":2931.16,"90th_percentile":2931.16,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":436.15,"10th_percentile":436.15,"90th_percentile":436.15,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9253.39,"10th_percentile":9253.39,"90th_percentile":9253.39,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Male Reproductive System With Mcc","code_information":[{"code":"722","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16880.56,"maximum":30152.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22903.14},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16880.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16880.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22294.74},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":22988.8},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24130.78},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16880.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16880.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":26229.11},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16880.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16880.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16880.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16880.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16880.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16880.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16880.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30152.0},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27541.51},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16880.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":34374.81,"10th_percentile":34374.81,"90th_percentile":34374.81,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11692.13,"10th_percentile":11692.13,"90th_percentile":11692.13,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Male Reproductive System With Cc","code_information":[{"code":"723","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10853.26,"maximum":19584.5,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14876.18},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10853.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10853.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14481.01},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":14931.82},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15673.56},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10853.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10853.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":17036.48},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10853.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10853.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10853.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10853.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10853.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10853.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10853.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19584.5},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17888.92},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10853.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":43660.62,"10th_percentile":43660.62,"90th_percentile":43660.62,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Male Reproductive System Without Cc/Mcc","code_information":[{"code":"724","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6452.52,"maximum":12707.51,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9652.49},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6452.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6452.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9396.08},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":9688.59},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10169.88},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6452.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6452.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11054.22},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6452.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6452.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6452.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6452.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6452.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6452.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6452.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12707.51},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11607.33},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6452.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Benign Prostatic Hypertrophy With Mcc","code_information":[{"code":"725","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11101.76,"maximum":22029.73,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16733.55},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11101.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11101.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16289.04},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":16796.14},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17630.49},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11101.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11101.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":19163.58},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11101.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11101.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11101.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11101.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11101.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11101.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11101.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22029.73},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20122.45},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11101.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Benign Prostatic Hypertrophy Without Mcc","code_information":[{"code":"726","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7051.63,"maximum":12981.34,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9860.49},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7051.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7051.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9598.55},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":9897.37},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10389.02},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7051.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7051.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11292.42},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7051.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7051.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7051.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7051.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7051.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7051.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7051.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12981.34},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11857.44},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7051.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4022.9,"10th_percentile":4022.9,"90th_percentile":4022.9,"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":"Youthcare","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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11753.56,"10th_percentile":11753.56,"90th_percentile":11753.56,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":25627.81,"10th_percentile":25627.81,"90th_percentile":25627.81,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10142.65,"10th_percentile":10142.65,"90th_percentile":10142.65,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammation Of The Male Reproductive System Without Mcc","code_information":[{"code":"728","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7857.68,"maximum":14251.04,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10824.94},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7857.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7857.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10537.39},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":10865.43},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11405.17},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7857.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7857.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":12396.93},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7857.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7857.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7857.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7857.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7857.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7857.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7857.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14251.04},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13017.22},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7857.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10738.96,"10th_percentile":10738.96,"90th_percentile":10738.96,"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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":5953.66,"10th_percentile":5953.66,"90th_percentile":5953.66,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":22758.01,"10th_percentile":22758.01,"90th_percentile":22758.01,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":3869.31,"10th_percentile":3869.31,"90th_percentile":3869.31,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5234.3,"10th_percentile":5234.3,"90th_percentile":5234.3,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":13190.23,"10th_percentile":13190.23,"90th_percentile":13190.23,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":160.37,"10th_percentile":160.37,"90th_percentile":160.37,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System Diagnoses With Cc/Mcc","code_information":[{"code":"729","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10094.2,"maximum":19199.05,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14583.4},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10094.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10094.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14196.0},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":14637.94},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15365.09},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10094.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10094.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":16701.18},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10094.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10094.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10094.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10094.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10094.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10094.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10094.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19199.05},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17536.84},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10094.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System Diagnoses Without Cc/Mcc","code_information":[{"code":"730","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6599.81,"maximum":10584.94,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8040.21},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6599.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6599.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7826.63},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":8070.28},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8471.18},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6599.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6599.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":9207.8},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6599.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6599.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6599.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6599.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6599.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6599.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6599.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10584.94},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9668.52},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6599.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/Mcc","code_information":[{"code":"734","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19774.93,"maximum":36673.19,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27856.57},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19774.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19774.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27116.59},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":27960.76},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29349.72},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19774.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19774.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":31901.87},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19774.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19774.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19774.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19774.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19774.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19774.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19774.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36673.19},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33498.11},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19774.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/Mcc","code_information":[{"code":"735","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12685.85,"maximum":21169.89,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16080.42},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12685.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12685.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15653.26},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":16140.57},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16942.35},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12685.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12685.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":18415.6},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12685.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12685.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12685.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12685.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12685.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12685.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12685.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21169.89},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19337.05},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12685.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14697.91,"10th_percentile":14697.91,"90th_percentile":14697.91,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc","code_information":[{"code":"736","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32828.05,"maximum":68670.45,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52161.35},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32828.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32828.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":50775.74},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":52356.44},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":54957.27},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32828.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32828.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":59736.16},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32828.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32828.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32828.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32828.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32828.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32828.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32828.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":68670.45},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":62725.13},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32828.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":49361.06,"10th_percentile":49361.06,"90th_percentile":88292.45,"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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc","code_information":[{"code":"737","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19147.8,"maximum":34852.35,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26473.48},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19147.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19147.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25770.24},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":26572.49},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27892.49},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19147.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19147.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":30317.93},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19147.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19147.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19147.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19147.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19147.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19147.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19147.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34852.35},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31834.92},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19147.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14190.01,"10th_percentile":14190.01,"90th_percentile":14190.01,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":105736.06,"10th_percentile":105736.06,"90th_percentile":105736.06,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":11044.16,"10th_percentile":11044.16,"90th_percentile":11044.16,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15932.77,"10th_percentile":15932.77,"90th_percentile":15932.77,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":68122.19,"10th_percentile":54514.81,"90th_percentile":88491.4,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13173.4,"10th_percentile":13173.4,"90th_percentile":13173.4,"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":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":35228.27,"10th_percentile":35228.27,"90th_percentile":35228.27,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15542.52,"10th_percentile":15542.52,"90th_percentile":15542.52,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/Mcc","code_information":[{"code":"738","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13797.33,"maximum":26454.51,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20094.57},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13797.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13797.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19560.77},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":20169.72},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21171.66},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13797.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13797.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":23012.68},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13797.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13797.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13797.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13797.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13797.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13797.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13797.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26454.51},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24164.14},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13797.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":101855.41,"10th_percentile":101855.41,"90th_percentile":101855.41,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":65701.99,"10th_percentile":65701.99,"90th_percentile":65701.99,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":92483.19,"10th_percentile":92483.19,"90th_percentile":92483.19,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":27250.4,"10th_percentile":27250.4,"90th_percentile":27250.4},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Mcc","code_information":[{"code":"739","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32903.05,"maximum":69427.39,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52736.31},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32903.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32903.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":51335.43},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":52933.56},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":55563.05},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32903.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32903.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":60394.62},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32903.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32903.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32903.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32903.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32903.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32903.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32903.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":69427.39},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":63416.53},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32903.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc","code_information":[{"code":"740","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16879.65,"maximum":31711.23,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24087.51},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16879.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16879.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23447.65},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":24177.61},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25378.64},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16879.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16879.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":27585.48},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16879.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16879.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16879.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16879.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16879.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16879.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16879.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31711.23},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28965.74},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16879.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":127822.17,"10th_percentile":127822.17,"90th_percentile":127822.17,"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":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":82475.41,"10th_percentile":82475.41,"90th_percentile":82475.41,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":87759.33,"10th_percentile":73707.92,"90th_percentile":97283.79,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13970.66,"10th_percentile":13970.66,"90th_percentile":13970.66,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":33512.97,"10th_percentile":33512.97,"90th_percentile":33512.97,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/Mcc","code_information":[{"code":"741","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13414.18,"maximum":23955.21,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18196.13},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13414.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13414.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17712.77},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":18264.18},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19171.46},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13414.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13414.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":20838.55},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13414.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13414.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13414.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13414.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13414.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13414.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13414.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23955.21},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21881.23},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13414.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15733.7,"10th_percentile":15733.7,"90th_percentile":15733.7,"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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":78571.18,"10th_percentile":78571.18,"90th_percentile":78571.18,"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":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":55783.73,"10th_percentile":55783.73,"90th_percentile":63754.69,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":16190.69,"10th_percentile":16190.69,"90th_percentile":16190.69,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Malignancy With Cc/Mcc","code_information":[{"code":"742","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17107.37,"maximum":31857.73,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24198.8},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17107.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17107.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23555.98},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":24289.3},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25495.88},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17107.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17107.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":27712.92},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17107.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17107.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17107.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17107.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17107.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17107.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17107.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31857.73},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29099.56},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17107.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24171.25,"10th_percentile":24171.25,"90th_percentile":24200.12,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24200.12,"10th_percentile":24200.12,"90th_percentile":24200.12,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":81929.25,"10th_percentile":81929.25,"90th_percentile":97868.33,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"14","median_amount":64828.66,"10th_percentile":39822.57,"90th_percentile":90290.48,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":7495.26,"10th_percentile":7495.26,"90th_percentile":7495.26,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14690.07,"10th_percentile":14690.07,"90th_percentile":14690.07,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":7508.21,"10th_percentile":7508.21,"90th_percentile":8055.26,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":31803.55,"10th_percentile":31803.55,"90th_percentile":31803.55,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":11738.83,"maximum":20904.78,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15879.05},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11738.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11738.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15457.24},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":15938.44},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16730.19},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11738.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11738.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":18184.99},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11738.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11738.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11738.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11738.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11738.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11738.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11738.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20904.78},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19094.9},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11738.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11820.25,"10th_percentile":11820.25,"90th_percentile":11820.25,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":7151.59,"10th_percentile":7151.59,"90th_percentile":7151.59,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9472.59,"10th_percentile":9472.59,"90th_percentile":9472.59,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":47872.73,"10th_percentile":47872.73,"90th_percentile":47872.73,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":66040.44,"10th_percentile":53538.19,"90th_percentile":103743.6,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"12","median_amount":64609.25,"10th_percentile":45901.05,"90th_percentile":74468.93,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":18273.43,"10th_percentile":18273.43,"90th_percentile":18273.43},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":5847.55,"10th_percentile":5847.55,"90th_percentile":5847.55,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":20906.53,"10th_percentile":19958.36,"90th_percentile":20906.53,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":19043.88,"maximum":34077.97,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25885.27},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19043.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19043.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25197.65},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":25982.08},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27272.75},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19043.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19043.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":29644.3},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19043.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19043.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19043.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19043.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19043.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19043.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19043.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34077.97},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31127.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19043.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7581.38,"10th_percentile":7581.38,"90th_percentile":7581.38,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":5911.41,"10th_percentile":5911.41,"90th_percentile":5911.41,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15185.68,"10th_percentile":15185.68,"90th_percentile":15185.68,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15175.47,"10th_percentile":15175.47,"90th_percentile":15175.47,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/Mcc","code_information":[{"code":"745","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10806.27,"maximum":17873.54,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13576.55},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10806.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10806.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13215.9},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":13627.33},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14304.27},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10806.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10806.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":15548.12},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10806.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10806.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10806.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10806.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10806.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10806.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10806.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17873.54},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16326.09},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10806.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":2912.69,"10th_percentile":2912.69,"90th_percentile":2912.69,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vagina, Cervix And Vulva Procedures With Cc/Mcc","code_information":[{"code":"746","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16224.51,"maximum":29204.95,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22183.78},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16224.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16224.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21594.49},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":22266.75},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23372.86},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16224.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16224.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":25405.28},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16224.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16224.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16224.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16224.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16224.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16224.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16224.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29204.95},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26676.46},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16224.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7432.98,"10th_percentile":7432.98,"90th_percentile":7432.98,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":5582.18,"10th_percentile":5582.18,"90th_percentile":5582.18,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vagina, Cervix And Vulva Procedures Without Cc/Mcc","code_information":[{"code":"747","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8295.95,"maximum":16657.9,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12653.16},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8295.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8295.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12317.05},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":12700.49},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13331.39},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8295.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8295.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":14490.64},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8295.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8295.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8295.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8295.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8295.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8295.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8295.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16657.9},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15215.7},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8295.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Female Reproductive System Reconstructive Procedures","code_information":[{"code":"748","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13063.57,"maximum":23758.13,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18046.43},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13063.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13063.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17567.04},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":18113.92},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19013.74},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13063.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13063.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":20667.11},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13063.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13063.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13063.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13063.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13063.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13063.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13063.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23758.13},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21701.21},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13063.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Female Reproductive System O.R. Procedures With Cc/Mcc","code_information":[{"code":"749","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23729.27,"maximum":45144.28,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34291.12},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23729.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23729.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33380.21},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":34419.38},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36129.17},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23729.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23729.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":39270.84},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23729.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23729.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23729.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23729.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23729.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23729.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23729.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45144.28},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41235.8},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23729.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Female Reproductive System O.R. Procedures Without Cc/Mcc","code_information":[{"code":"750","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13863.29,"maximum":22490.17,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17083.3},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13863.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13863.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16629.5},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":17147.19},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17998.98},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13863.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13863.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":19564.11},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13863.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13863.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13863.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13863.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13863.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13863.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13863.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22490.17},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20543.02},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13863.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":81678.69,"10th_percentile":81678.69,"90th_percentile":81678.69,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":13404.0,"10th_percentile":13404.0,"90th_percentile":13404.0},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":8896.33,"10th_percentile":8896.33,"90th_percentile":8896.33,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Female Reproductive System With Mcc","code_information":[{"code":"754","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17169.72,"maximum":31554.26,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23968.28},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17169.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17169.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23331.59},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":24057.93},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25253.01},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17169.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17169.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":27448.93},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17169.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17169.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17169.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17169.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17169.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17169.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17169.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31554.26},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28822.37},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17169.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":37791.4,"10th_percentile":37791.4,"90th_percentile":37791.4,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14208.1,"10th_percentile":14208.1,"90th_percentile":14208.1,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":258.37,"10th_percentile":258.37,"90th_percentile":258.37,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Female Reproductive System With Cc","code_information":[{"code":"755","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10357.16,"maximum":19361.25,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14706.6},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10357.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10357.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14315.94},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":14761.61},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15494.9},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10357.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10357.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":16842.28},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10357.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10357.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10357.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10357.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10357.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10357.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10357.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19361.25},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17685.0},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10357.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14227.88,"10th_percentile":14227.88,"90th_percentile":14227.88,"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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":7576.27,"10th_percentile":7576.27,"90th_percentile":7576.27,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8791.38,"10th_percentile":8791.38,"90th_percentile":8791.38,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":86804.6,"10th_percentile":86804.6,"90th_percentile":86804.6,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8150.68,"10th_percentile":8150.68,"90th_percentile":8150.68,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Female Reproductive System Without Cc/Mcc","code_information":[{"code":"756","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9206.82,"maximum":16654.41,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12650.52},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9206.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9206.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12314.47},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":12697.83},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13328.6},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9206.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9206.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":14487.61},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9206.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9206.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9206.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9206.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9206.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9206.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9206.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16654.41},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15212.51},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9206.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infections, Female Reproductive System With Mcc","code_information":[{"code":"757","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13466.59,"maximum":24682.5,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18748.57},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13466.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13466.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18250.53},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":18818.69},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19753.52},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13466.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13466.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":21471.22},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13466.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13466.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13466.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13466.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13466.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13466.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13466.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24682.5},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22545.55},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13466.59,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":32996.15,"10th_percentile":32996.15,"90th_percentile":32996.15,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8850.37,"10th_percentile":8850.37,"90th_percentile":8850.37,"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 Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infections, Female Reproductive System With Cc","code_information":[{"code":"758","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9373.99,"maximum":17777.61,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13503.69},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9373.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9373.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13144.97},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":13554.19},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14227.5},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9373.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9373.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":15464.68},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9373.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9373.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9373.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9373.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9373.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9373.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9373.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17777.61},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16238.47},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9373.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":47166.22,"10th_percentile":47166.22,"90th_percentile":47166.22,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18480.23,"10th_percentile":18480.23,"90th_percentile":18480.23,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":26317.89,"10th_percentile":26317.89,"90th_percentile":47569.45,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":100.0,"10th_percentile":100.0,"90th_percentile":100.0,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":6523.9,"maximum":11160.5,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8477.4},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6523.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6523.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8252.2},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":8509.1},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8931.79},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6523.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6523.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":9708.47},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6523.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6523.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6523.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6523.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6523.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6523.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6523.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11160.5},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10194.25},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6523.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":23339.88,"10th_percentile":23339.88,"90th_percentile":23339.88,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":3499.24,"10th_percentile":3499.24,"90th_percentile":3499.24,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4470.13,"10th_percentile":4470.13,"90th_percentile":4470.13,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":1873.4,"10th_percentile":1873.4,"90th_percentile":1873.4,"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":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Menstrual And Other Female Reproductive System Disorders With Cc/Mcc","code_information":[{"code":"760","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9631.53,"maximum":17188.11,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13055.9},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9631.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9631.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12709.09},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":13104.74},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13755.72},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9631.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9631.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":14951.87},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9631.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9631.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9631.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9631.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9631.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9631.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9631.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17188.11},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15700.0},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9631.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12582.83,"10th_percentile":12582.83,"90th_percentile":12582.83,"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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7855.12,"10th_percentile":7855.12,"90th_percentile":8295.14,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21847.04,"10th_percentile":21847.04,"90th_percentile":21847.04,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":2912.69,"10th_percentile":2912.69,"90th_percentile":2912.69,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":34989.62,"10th_percentile":21980.96,"90th_percentile":45656.01,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Menstrual And Other Female Reproductive System Disorders Without Cc/Mcc","code_information":[{"code":"761","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5682.61,"maximum":11055.85,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8397.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5682.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5682.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8174.83},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":8429.32},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8848.05},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5682.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5682.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":9617.44},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5682.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5682.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5682.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5682.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5682.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5682.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5682.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11055.85},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10098.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5682.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":1102.48,"10th_percentile":1102.48,"90th_percentile":1102.48,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":3037.5,"10th_percentile":3037.5,"90th_percentile":3037.5,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C","code_information":[{"code":"768","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10210.77,"maximum":19120.57,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14523.78},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10210.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10210.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14137.97},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":14578.1},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15302.28},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10210.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10210.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":16632.91},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10210.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10210.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10210.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10210.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10210.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10210.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10210.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19120.57},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17465.16},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10210.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"24","median_amount":13704.49,"10th_percentile":8442.95,"90th_percentile":14523.78,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":5426.86,"10th_percentile":5419.67,"90th_percentile":7949.14,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"19","median_amount":25516.23,"10th_percentile":20130.21,"90th_percentile":92536.39,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"29","median_amount":26011.26,"10th_percentile":20223.58,"90th_percentile":39908.95,"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":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":5159.09,"10th_percentile":4428.18,"90th_percentile":7627.18,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"98","median_amount":24766.32,"10th_percentile":19062.92,"90th_percentile":39591.58,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"14","median_amount":8040.04,"10th_percentile":6703.82,"90th_percentile":10144.26},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":5706.19,"10th_percentile":4428.18,"90th_percentile":6185.8,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"20","median_amount":5615.95,"10th_percentile":4333.41,"90th_percentile":7387.2,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":5728.27,"10th_percentile":5728.27,"90th_percentile":7772.1,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"22","median_amount":12047.5,"10th_percentile":10107.0,"90th_percentile":12330.0,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"1 through 10","median_amount":11162.0,"10th_percentile":11162.0,"90th_percentile":11262.0,"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":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postpartum And Post Abortion Diagnoses 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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":36336.62,"10th_percentile":36336.62,"90th_percentile":277172.29,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":29411.09,"10th_percentile":29411.09,"90th_percentile":84300.84,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":19992.81,"10th_percentile":19992.81,"90th_percentile":19992.81},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","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":"1 through 10","median_amount":5014.26,"10th_percentile":4872.55,"90th_percentile":12492.46,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":24234.27,"10th_percentile":24234.27,"90th_percentile":24234.27,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"1 through 10","median_amount":22136.12,"10th_percentile":22136.12,"90th_percentile":22136.12,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Abortion With D&C, Aspiration Curettage Or Hysterotomy","code_information":[{"code":"770","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9588.16,"maximum":18764.77,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14253.52},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9588.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9588.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13874.89},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":14306.83},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15017.53},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9588.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9588.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":16323.4},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9588.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9588.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9588.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9588.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9588.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9588.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9588.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18764.77},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17140.16},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9588.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14126.5,"10th_percentile":14126.5,"90th_percentile":14126.5,"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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":5148.62,"10th_percentile":5148.62,"90th_percentile":5148.62,"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":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":427.1,"10th_percentile":427.1,"90th_percentile":427.1,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":37579.37,"10th_percentile":37579.37,"90th_percentile":41452.92,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":11762.93,"10th_percentile":11762.93,"90th_percentile":11762.93},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":414.9,"10th_percentile":414.9,"90th_percentile":414.9,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":5148.62,"10th_percentile":5148.62,"90th_percentile":5148.62,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postpartum And Post Abortion Diagnoses Without O.R. Procedures","code_information":[{"code":"776","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6443.48,"maximum":12442.41,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9451.12},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6443.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6443.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9200.06},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":9486.47},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9957.72},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6443.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6443.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10823.6},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6443.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6443.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6443.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6443.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6443.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6443.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6443.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12442.41},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11365.18},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6443.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9028.6,"10th_percentile":6192.1,"90th_percentile":9452.45,"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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":5552.0,"10th_percentile":5552.0,"90th_percentile":5552.0,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":12426.5,"10th_percentile":5335.65,"90th_percentile":62524.53,"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":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"12","median_amount":14917.95,"10th_percentile":11050.88,"90th_percentile":24419.7,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":2985.32,"10th_percentile":2505.6,"90th_percentile":3867.7,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"22","median_amount":15827.73,"10th_percentile":11318.38,"90th_percentile":34231.78,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":4761.92,"10th_percentile":3585.27,"90th_percentile":6671.23},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":3524.14,"10th_percentile":3524.14,"90th_percentile":6430.81,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":3524.14,"10th_percentile":267.75,"90th_percentile":5819.76,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":3332.42,"10th_percentile":3332.42,"90th_percentile":3332.42,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":12444.15,"10th_percentile":9293.49,"90th_percentile":12444.15,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"1 through 10","median_amount":11366.77,"10th_percentile":11366.77,"90th_percentile":11366.77,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1651.39,"10th_percentile":1651.39,"90th_percentile":1651.39,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":8129.68,"maximum":16302.1,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12382.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8129.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8129.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12053.97},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":12429.22},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13046.65},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8129.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8129.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":14181.14},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8129.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8129.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8129.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8129.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8129.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8129.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8129.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16302.1},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14890.71},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8129.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16396.23,"10th_percentile":16396.23,"90th_percentile":16396.23,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":4756.78,"10th_percentile":4756.78,"90th_percentile":4756.78,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":16706.83,"10th_percentile":16706.83,"90th_percentile":27192.8,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":3933.83,"10th_percentile":3933.83,"90th_percentile":4046.77,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc","code_information":[{"code":"556","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8032.99,"maximum":14240.58,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10816.99},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8032.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8032.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10529.65},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":10857.45},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11396.8},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8032.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8032.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":12387.82},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8032.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8032.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8032.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8032.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8032.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8032.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8032.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14240.58},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13007.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8032.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":5763.91,"10th_percentile":5763.91,"90th_percentile":5763.91,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6929.4,"10th_percentile":6929.4,"90th_percentile":6929.4,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22041.89,"10th_percentile":22041.89,"90th_percentile":22041.89,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":5140.33,"10th_percentile":5140.33,"90th_percentile":5140.33,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6567.45,"10th_percentile":6567.45,"90th_percentile":6567.45,"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":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":23556.28,"10th_percentile":23556.28,"90th_percentile":25752.88,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":3102.63,"10th_percentile":3102.63,"90th_percentile":3102.63,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":3102.63,"10th_percentile":3102.63,"90th_percentile":3102.63,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6842.58,"10th_percentile":6842.58,"90th_percentile":6842.58,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":13963.6,"maximum":27028.32,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20530.43},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13963.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13963.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19985.06},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":20607.21},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21630.88},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13963.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13963.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":23511.83},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13963.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13963.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13963.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13963.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13963.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13963.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13963.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27028.32},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24688.27},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13963.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":56241.58,"10th_percentile":56241.58,"90th_percentile":56241.58,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":49703.48,"10th_percentile":49703.48,"90th_percentile":49703.48,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12121.25,"10th_percentile":12121.25,"90th_percentile":12121.25,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tendonitis, Myositis And Bursitis Without Mcc","code_information":[{"code":"558","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8598.67,"maximum":15065.54,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11443.62},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8598.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8598.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11139.63},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11486.42},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12057.02},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8598.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8598.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":13105.45},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8598.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8598.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8598.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8598.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8598.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8598.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8598.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15065.54},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13761.2},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8598.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9861.3,"10th_percentile":9861.3,"90th_percentile":9861.3,"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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7310.26,"10th_percentile":7310.26,"90th_percentile":7310.26,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21111.37,"10th_percentile":21111.37,"90th_percentile":21111.37,"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":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":4261.52,"10th_percentile":4261.52,"90th_percentile":5140.33,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8381.35,"10th_percentile":8381.35,"90th_percentile":8381.35,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":22436.24,"10th_percentile":12896.23,"90th_percentile":33394.03,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":6204.07,"10th_percentile":6204.07,"90th_percentile":6204.07},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6949.14,"10th_percentile":6949.14,"90th_percentile":6962.3,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5365.12,"10th_percentile":5365.12,"90th_percentile":5365.12,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":3672.94,"10th_percentile":3672.94,"90th_percentile":3672.94,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":4261.52,"10th_percentile":4261.52,"90th_percentile":4261.52,"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":"Aftercare, Musculoskeletal System And Connective Tissue With Mcc","code_information":[{"code":"559","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17379.37,"maximum":32372.24,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24589.61},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17379.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17379.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23936.41},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":24681.58},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25907.65},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17379.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17379.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":28160.49},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17379.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17379.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17379.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17379.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17379.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17379.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17379.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32372.24},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29569.53},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17379.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14464.71,"10th_percentile":14464.71,"90th_percentile":14464.71,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14456.43,"10th_percentile":14456.43,"90th_percentile":14456.43,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare, Musculoskeletal System And Connective Tissue With Cc","code_information":[{"code":"560","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10703.25,"maximum":19861.81,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15086.82},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10703.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10703.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14686.06},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":15143.25},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15895.5},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10703.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10703.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":17277.71},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10703.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10703.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10703.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10703.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10703.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10703.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10703.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19861.81},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18142.22},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10703.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7377.45,"10th_percentile":7377.45,"90th_percentile":7377.45,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9015.19,"10th_percentile":9015.19,"90th_percentile":9015.19,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":7791.72,"maximum":14259.76,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10831.56},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7791.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7791.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10543.84},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":10872.08},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11412.15},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7791.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7791.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":12404.51},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7791.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7791.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7791.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7791.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7791.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7791.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7791.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14259.76},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13025.19},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7791.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":13572.86,"10th_percentile":13572.86,"90th_percentile":13572.86,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":19933.23,"10th_percentile":19933.23,"90th_percentile":19933.23,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11471.5,"10th_percentile":11471.5,"90th_percentile":11471.5,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":116562.42,"10th_percentile":116562.42,"90th_percentile":116562.42,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":75494.98,"10th_percentile":75494.98,"90th_percentile":75494.98,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":6351.75,"10th_percentile":6351.75,"90th_percentile":6351.75,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5461.97,"10th_percentile":5461.97,"90th_percentile":10179.19,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11511.28,"10th_percentile":10497.5,"90th_percentile":11516.9,"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":"Youthcare","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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7172.11,"10th_percentile":7171.2,"90th_percentile":17699.72,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":40037.86,"10th_percentile":40037.86,"90th_percentile":40037.86,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7180.14,"10th_percentile":7180.14,"90th_percentile":7180.14,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":35273.96,"10th_percentile":32075.86,"90th_percentile":56842.56,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5437.99,"10th_percentile":5230.62,"90th_percentile":5909.64,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":6479.55,"10th_percentile":6479.55,"90th_percentile":6479.55,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4913.43,"10th_percentile":4913.43,"90th_percentile":4913.43,"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":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":589.16,"10th_percentile":589.16,"90th_percentile":589.16,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6695.46,"10th_percentile":285.67,"90th_percentile":7169.5,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":14475.96,"maximum":27368.42,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20788.76},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14475.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14475.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20236.53},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":20866.52},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21903.07},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14475.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14475.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":23807.68},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14475.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14475.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14475.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14475.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14475.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14475.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14475.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27368.42},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24998.93},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14475.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12268.93,"10th_percentile":12268.93,"90th_percentile":12268.93,"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":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12332.16,"10th_percentile":12332.16,"90th_percentile":12332.16,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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":9332.43,"maximum":17782.84,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13507.66},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9332.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9332.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13148.84},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":13558.18},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14231.69},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9332.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9332.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":15469.23},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9332.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9332.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9332.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9332.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9332.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9332.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9332.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17782.84},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16243.25},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9332.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8041.51,"10th_percentile":8041.51,"90th_percentile":8041.51,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":4652.98,"10th_percentile":4652.98,"90th_percentile":4652.98,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10000.0,"10th_percentile":10000.0,"90th_percentile":10000.0,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9518.64,"10th_percentile":9518.64,"90th_percentile":9518.64,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8113.67,"10th_percentile":8113.67,"90th_percentile":8146.14,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":7298.33,"maximum":13045.87,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9909.5},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7298.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7298.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9646.27},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":9946.57},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10440.67},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7298.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7298.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11348.55},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7298.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7298.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7298.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7298.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7298.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7298.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7298.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13045.87},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11916.39},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7298.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":61.74,"10th_percentile":61.74,"90th_percentile":61.74,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":27104.37,"maximum":52504.39,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39881.78},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27104.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27104.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38822.36},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":40030.94},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":42019.49},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27104.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27104.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":45673.37},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27104.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27104.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27104.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27104.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27104.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27104.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27104.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52504.39},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":47958.68},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27104.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23203.1,"10th_percentile":23203.1,"90th_percentile":23203.1,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":53949.22,"10th_percentile":53949.22,"90th_percentile":53949.22,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17148.31,"10th_percentile":17148.31,"90th_percentile":17148.31,"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":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":78045.05,"10th_percentile":78045.05,"90th_percentile":78045.05,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":37435.47,"10th_percentile":37435.47,"90th_percentile":37435.47},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":15794.38,"maximum":29210.19,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22187.75},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15794.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15794.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21598.35},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":22270.74},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23377.04},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15794.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15794.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":25409.83},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15794.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15794.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15794.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15794.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15794.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15794.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15794.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29210.19},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26681.24},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15794.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":60207.86,"10th_percentile":60207.86,"90th_percentile":60207.86,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":5728.25,"10th_percentile":5728.25,"90th_percentile":5728.25,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13080.65,"10th_percentile":13080.65,"90th_percentile":13080.65,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":6056.74,"10th_percentile":6056.74,"90th_percentile":6056.74,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":29201.47,"10th_percentile":29201.47,"90th_percentile":29201.47,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"1 through 10","median_amount":26673.27,"10th_percentile":26673.27,"90th_percentile":26673.27,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":10885.79,"maximum":19924.6,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15134.52},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10885.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10885.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14732.48},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":15191.12},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15945.74},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10885.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10885.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":17332.33},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10885.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10885.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10885.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10885.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10885.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10885.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10885.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19924.6},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18199.57},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10885.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10563.11,"10th_percentile":10563.11,"90th_percentile":10563.11,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6662.32,"10th_percentile":6662.32,"90th_percentile":6662.32,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft For Skin Ulcer Or Cellulitis With Mcc","code_information":[{"code":"573","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":59728.6,"maximum":107398.19,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":81578.53},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59728.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59728.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":79411.48},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":81883.65},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":85951.25},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59728.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59728.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":93425.28},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59728.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59728.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59728.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59728.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59728.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59728.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59728.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":107398.19},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":98099.91},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59728.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft For Skin Ulcer Or Cellulitis With Cc","code_information":[{"code":"574","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":31896.39,"maximum":60427.83,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45900.35},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31896.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31896.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44681.05},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":46072.02},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":48360.66},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31896.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31896.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":52565.94},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31896.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31896.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31896.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31896.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31896.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31896.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31896.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60427.83},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":55196.14},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31896.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft For Skin Ulcer Or Cellulitis Without Cc/Mcc","code_information":[{"code":"575","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16765.79,"maximum":34820.96,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26449.63},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16765.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16765.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25747.02},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":26548.56},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27867.37},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16765.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16765.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":30290.62},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16765.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16765.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16765.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16765.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16765.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16765.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16765.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34820.96},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31806.24},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16765.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc","code_information":[{"code":"576","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":44816.68,"maximum":94092.45,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":71471.64},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44816.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44816.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":69573.06},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":71738.95},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":75302.61},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44816.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44816.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":81850.67},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44816.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44816.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44816.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44816.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44816.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44816.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44816.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":94092.45},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":85946.15},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44816.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft Except For Skin Ulcer Or Cellulitis With Cc","code_information":[{"code":"577","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24480.19,"maximum":46438.41,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35274.12},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24480.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24480.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34337.1},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":35406.06},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37164.86},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24480.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24480.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":40396.59},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24480.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24480.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24480.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24480.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24480.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24480.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24480.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46438.41},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":42417.88},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24480.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":52729.67,"10th_percentile":52729.67,"90th_percentile":52729.67,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":46441.89,"10th_percentile":46441.89,"90th_percentile":46441.89,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/Mcc","code_information":[{"code":"578","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15043.45,"maximum":29480.52,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22393.09},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15043.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15043.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21798.24},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":22476.85},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23593.39},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15043.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15043.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":25644.99},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15043.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15043.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15043.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15043.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15043.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15043.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15043.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29480.52},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26928.17},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15043.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc","code_information":[{"code":"579","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29791.81,"maximum":56841.96,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43176.56},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29791.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29791.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":42029.61},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":43338.05},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":45490.88},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29791.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29791.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":49446.61},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29791.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29791.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29791.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29791.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29791.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29791.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29791.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56841.96},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":51920.72},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29791.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":29167.14,"10th_percentile":29167.14,"90th_percentile":29167.14,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24974.43,"10th_percentile":24974.43,"90th_percentile":24974.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25519.46,"10th_percentile":25519.46,"90th_percentile":25519.46,"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":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":108549.61,"10th_percentile":108549.61,"90th_percentile":108549.61,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":28690.67,"10th_percentile":28690.67,"90th_percentile":28690.67,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25094.18,"10th_percentile":25094.18,"90th_percentile":25094.18,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Skin, Subcutaneous Tissue And Breast Procedures With Cc","code_information":[{"code":"580","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16142.28,"maximum":30921.15,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23487.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16142.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16142.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22863.46},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":23575.23},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24746.33},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16142.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16142.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":26898.19},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16142.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16142.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16142.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16142.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16142.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16142.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16142.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30921.15},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28244.07},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16142.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21542.54,"10th_percentile":21542.54,"90th_percentile":21542.54,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12681.74,"10th_percentile":12681.74,"90th_percentile":13816.64,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25201.45,"10th_percentile":25201.45,"90th_percentile":25201.45,"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":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":8079.96,"10th_percentile":8079.96,"90th_percentile":8079.96,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9239.61,"10th_percentile":9239.61,"90th_percentile":13823.82,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":7181.04,"10th_percentile":7181.04,"90th_percentile":7181.04,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11545.43,"10th_percentile":11545.43,"90th_percentile":11545.43,"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":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":20729.96,"10th_percentile":20729.96,"90th_percentile":20729.96,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12450.01,"10th_percentile":12450.01,"90th_percentile":13759.74,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/Mcc","code_information":[{"code":"581","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13567.8,"maximum":25099.34,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19065.2},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13567.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13567.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18558.75},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":19136.5},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20087.12},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13567.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13567.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":21833.82},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13567.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13567.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13567.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13567.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13567.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13567.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13567.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25099.34},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22926.3},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13567.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":57094.89,"10th_percentile":57094.89,"90th_percentile":57094.89,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10980.61,"10th_percentile":10980.61,"90th_percentile":10980.61,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":25101.09,"10th_percentile":20118.08,"90th_percentile":25101.09,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10549.23,"10th_percentile":10549.23,"90th_percentile":10549.23,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mastectomy For Malignancy With Cc/Mcc","code_information":[{"code":"582","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17936.92,"maximum":30540.94,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23198.57},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17936.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17936.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22582.33},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":23285.34},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24442.05},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17936.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17936.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":26567.44},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17936.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17936.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17936.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17936.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17936.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17936.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17936.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30540.94},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27896.77},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17936.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":57375.82,"10th_percentile":57375.82,"90th_percentile":57375.82,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mastectomy For Malignancy Without Cc/Mcc","code_information":[{"code":"583","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16109.75,"maximum":28646.84,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21759.84},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16109.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16109.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21181.81},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":21841.23},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22926.2},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16109.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16109.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":24919.78},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16109.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16109.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16109.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16109.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16109.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16109.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16109.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28646.84},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26166.67},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16109.75,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":11769.87,"10th_percentile":11769.87,"90th_percentile":11769.87,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":96068.55,"10th_percentile":96068.55,"90th_percentile":96068.55,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":82766.68,"10th_percentile":82766.68,"90th_percentile":82766.68,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":100662.49,"10th_percentile":100662.49,"90th_percentile":100662.49,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Breast Biopsy, Local Excision And Other Breast Procedures With Cc/Mcc","code_information":[{"code":"584","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19871.62,"maximum":35706.96,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27122.63},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19871.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19871.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26402.14},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":27224.07},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28576.44},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19871.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19871.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":31061.35},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19871.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19871.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19871.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19871.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19871.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19871.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19871.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35706.96},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32615.54},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19871.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":16461.28,"10th_percentile":16461.28,"90th_percentile":16461.28,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":7675.4,"10th_percentile":7675.4,"90th_percentile":7675.4},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/Mcc","code_information":[{"code":"585","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17959.51,"maximum":34620.39,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26297.28},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17959.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17959.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25598.72},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":26395.64},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27706.85},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17959.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17959.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":30116.14},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17959.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17959.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17959.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17959.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17959.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17959.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17959.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34620.39},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31623.04},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17959.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25547.89,"10th_percentile":25547.89,"90th_percentile":26298.6,"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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":84871.61,"10th_percentile":84871.61,"90th_percentile":84871.61,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":94709.23,"10th_percentile":89098.87,"90th_percentile":97966.68,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":18965.29,"10th_percentile":18965.29,"90th_percentile":18965.29},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":12969.05,"10th_percentile":12969.05,"90th_percentile":12969.05,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":34622.13,"10th_percentile":34622.13,"90th_percentile":34622.13,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Ulcers With Mcc","code_information":[{"code":"592","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18015.53,"maximum":35862.18,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27240.54},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18015.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18015.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26516.92},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":27342.42},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28700.67},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18015.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18015.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":31196.38},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18015.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18015.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18015.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18015.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18015.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18015.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18015.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35862.18},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32757.32},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18015.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13810.67,"10th_percentile":13810.67,"90th_percentile":13810.67,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15479.83,"10th_percentile":15479.83,"90th_percentile":15479.83,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":6834.67,"10th_percentile":6834.67,"90th_percentile":6834.67,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15958.59,"10th_percentile":15958.59,"90th_percentile":15958.59,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Ulcers With Cc","code_information":[{"code":"593","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11247.25,"maximum":21323.37,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16197.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11247.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11247.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15766.75},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":16257.58},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17065.19},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11247.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11247.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":18549.12},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11247.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11247.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11247.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11247.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11247.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11247.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11247.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21323.37},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19477.24},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11247.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10418.94,"10th_percentile":10418.94,"90th_percentile":10418.94,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9848.97,"10th_percentile":9848.97,"90th_percentile":9848.97,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7829.93,"10th_percentile":7829.93,"90th_percentile":7829.93,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Ulcers Without Cc/Mcc","code_information":[{"code":"594","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8360.11,"maximum":14800.43,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11242.25},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8360.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8360.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10943.61},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11284.3},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11844.85},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8360.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8360.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":12874.84},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8360.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8360.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8360.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8360.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8360.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8360.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8360.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14800.43},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13519.05},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8360.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Skin Disorders With Mcc","code_information":[{"code":"595","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19690.89,"maximum":36887.72,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28019.52},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19690.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19690.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27275.21},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":28124.32},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29521.4},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19690.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19690.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":32088.48},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19690.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19690.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19690.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19690.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19690.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19690.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19690.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36887.72},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33694.07},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19690.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Skin Disorders Without Mcc","code_information":[{"code":"596","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10309.27,"maximum":18853.72,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14321.09},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10309.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10309.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13940.66},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":14374.65},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15088.72},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10309.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10309.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":16400.78},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10309.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10309.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10309.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10309.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10309.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10309.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10309.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18853.72},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17221.41},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10309.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":962.25,"10th_percentile":962.25,"90th_percentile":962.25,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":27120.42,"10th_percentile":27120.42,"90th_percentile":27120.42,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1232.49,"10th_percentile":1232.49,"90th_percentile":1232.49,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6936.68,"10th_percentile":6936.68,"90th_percentile":6936.68,"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":"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":4262.42,"10th_percentile":4262.42,"90th_percentile":4262.42,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8600.19,"10th_percentile":8600.19,"90th_percentile":8600.19,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignant Breast Disorders With Mcc","code_information":[{"code":"597","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15591.96,"maximum":30635.12,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23270.11},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15591.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15591.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22651.96},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":23357.15},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24517.42},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15591.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15591.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":26649.37},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15591.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15591.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15591.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15591.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15591.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15591.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15591.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30635.12},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27982.8},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15591.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":18317.66,"10th_percentile":18317.66,"90th_percentile":18317.66},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":6154.18,"10th_percentile":6154.18,"90th_percentile":6154.18,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignant Breast Disorders With Cc","code_information":[{"code":"598","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10750.24,"maximum":18817.09,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14293.27},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10750.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10750.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13913.58},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":14346.73},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15059.4},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10750.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10750.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":16368.92},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10750.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10750.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10750.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10750.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10750.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10750.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10750.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18817.09},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17187.96},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10750.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":6555.24,"10th_percentile":6555.24,"90th_percentile":6555.24,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":5709.79,"10th_percentile":5709.79,"90th_percentile":5709.79,"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":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8562.48,"10th_percentile":8562.48,"90th_percentile":8562.48,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignant Breast Disorders Without Cc/Mcc","code_information":[{"code":"599","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7479.96,"maximum":14910.31,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11325.72},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7479.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7479.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11024.86},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11368.08},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11932.79},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7479.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7479.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":12970.42},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7479.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7479.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7479.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7479.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7479.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7479.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7479.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14910.31},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13619.41},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7479.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Malignant Breast Disorders With Cc/Mcc","code_information":[{"code":"600","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9939.68,"maximum":16694.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12680.99},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9939.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9939.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12344.13},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":12728.41},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13360.7},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9939.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9939.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":14522.5},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9939.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9939.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9939.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9939.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9939.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9939.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9939.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16694.53},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15249.15},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9939.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6670.5,"10th_percentile":6670.5,"90th_percentile":6670.5,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Malignant Breast Disorders Without Cc/Mcc","code_information":[{"code":"601","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5994.37,"maximum":10455.88,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7942.18},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5994.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5994.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7731.2},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":7971.88},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8367.89},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5994.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5994.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":9095.53},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5994.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5994.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5994.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5994.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5994.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5994.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5994.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10455.88},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9550.63},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5994.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7942.18,"10th_percentile":7942.18,"90th_percentile":7942.18,"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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15547.21,"10th_percentile":15547.21,"90th_percentile":15547.21,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":6149.26,"10th_percentile":6149.26,"90th_percentile":6149.26,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":9479.85,"10th_percentile":9479.85,"90th_percentile":9479.85},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cellulitis With Mcc","code_information":[{"code":"602","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13370.81,"maximum":25627.81,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19466.61},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13370.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13370.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18949.5},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":19539.42},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20510.05},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13370.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13370.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":22293.53},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13370.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13370.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13370.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13370.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13370.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13370.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13370.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25627.81},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23409.01},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13370.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":50461.6,"10th_percentile":50461.6,"90th_percentile":50461.6,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7065.14,"10th_percentile":6621.45,"90th_percentile":11511.46,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":22353.49,"10th_percentile":22353.49,"90th_percentile":22353.49,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":66792.89,"10th_percentile":66792.89,"90th_percentile":66792.89,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":6143.48,"10th_percentile":6143.48,"90th_percentile":6143.48,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11520.69,"10th_percentile":11520.69,"90th_percentile":11520.69,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":52830.61,"10th_percentile":33108.33,"90th_percentile":58247.83,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11489.85,"10th_percentile":11489.85,"90th_percentile":11489.85,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11640.51,"10th_percentile":11640.51,"90th_percentile":11640.51,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":10791.58,"10th_percentile":10791.58,"90th_percentile":10791.58,"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":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8898.98,"10th_percentile":8898.98,"90th_percentile":8898.98,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cellulitis Without Mcc","code_information":[{"code":"603","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8397.16,"maximum":15363.78,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11670.16},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8397.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8397.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11360.16},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11713.81},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12295.7},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8397.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8397.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":13364.89},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8397.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8397.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8397.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8397.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8397.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8397.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8397.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15363.78},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14033.62},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8397.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11668.84,"10th_percentile":10093.52,"90th_percentile":27561.59,"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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":4403.0,"10th_percentile":227.16,"90th_percentile":7201.15,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"17","median_amount":7060.04,"10th_percentile":1988.86,"90th_percentile":7073.84,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7057.32,"10th_percentile":7057.32,"90th_percentile":7057.32,"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":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":37397.81,"10th_percentile":19139.17,"90th_percentile":44858.51,"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":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20250.55,"10th_percentile":13769.55,"90th_percentile":90810.39,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":5585.89,"10th_percentile":3827.99,"90th_percentile":8079.96,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7060.57,"10th_percentile":6613.32,"90th_percentile":7240.52,"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":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6848.75,"10th_percentile":6848.75,"90th_percentile":6848.75,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"38","median_amount":20774.12,"10th_percentile":11729.53,"90th_percentile":51983.58,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":6438.07,"10th_percentile":6042.03,"90th_percentile":6493.01},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5849.37,"10th_percentile":5849.37,"90th_percentile":5849.37,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":4204.47,"10th_percentile":3131.0,"90th_percentile":20194.89,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6359.06,"10th_percentile":6359.06,"90th_percentile":6359.06,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"17","median_amount":6633.33,"10th_percentile":5878.51,"90th_percentile":7248.42,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5492.47,"10th_percentile":5492.47,"90th_percentile":5492.47,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"13","median_amount":4070.73,"10th_percentile":1229.95,"90th_percentile":5083.28,"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":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":4288.56,"10th_percentile":4288.56,"90th_percentile":4288.56,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":15189.37,"10th_percentile":6485.53,"90th_percentile":15362.03,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"1 through 10","median_amount":13492.09,"10th_percentile":13492.09,"90th_percentile":13492.09,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"23","median_amount":6249.16,"10th_percentile":282.87,"90th_percentile":7240.53,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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":13829.86,"maximum":25912.09,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19682.55},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13829.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13829.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19159.71},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":19756.17},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20737.56},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13829.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13829.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":22540.83},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13829.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13829.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13829.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13829.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13829.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13829.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13829.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25912.09},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23668.69},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13829.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11882.08,"10th_percentile":11882.08,"90th_percentile":11882.08,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11628.29,"10th_percentile":11628.29,"90th_percentile":11628.29,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11636.46,"10th_percentile":11636.46,"90th_percentile":11636.46,"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":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":44658.05,"10th_percentile":44658.05,"90th_percentile":44658.05,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":30162.26,"10th_percentile":30162.26,"90th_percentile":31005.39,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5440.45,"10th_percentile":5440.45,"90th_percentile":5440.45,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":8804.7,"maximum":16110.25,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12237.18},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8804.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8804.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11912.11},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":12282.95},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12893.11},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8804.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8804.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":14014.25},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8804.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8804.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8804.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8804.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8804.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8804.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8804.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16110.25},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14715.46},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8804.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7588.72,"10th_percentile":6503.82,"90th_percentile":7590.25,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":24781.33,"10th_percentile":24781.33,"90th_percentile":24781.33,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19992.68,"10th_percentile":19992.68,"90th_percentile":19992.68,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7385.82,"10th_percentile":7385.82,"90th_percentile":7588.72,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":5057.03,"10th_percentile":5057.03,"90th_percentile":5057.03,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7379.19,"10th_percentile":7103.2,"90th_percentile":9316.9,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":10000.0,"10th_percentile":10000.0,"90th_percentile":10000.0,"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":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":15729.32,"10th_percentile":15729.32,"90th_percentile":15729.32,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7588.72,"10th_percentile":7588.72,"90th_percentile":7588.72,"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":"Youthcare","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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":24895.96,"10th_percentile":24895.96,"90th_percentile":24895.96,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12507.56,"10th_percentile":12507.56,"90th_percentile":12507.56,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Skin Disorders Without Mcc","code_information":[{"code":"607","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8717.95,"maximum":15074.26,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11450.25},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8717.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8717.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11146.08},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11493.07},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12063.99},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8717.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8717.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":13113.04},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8717.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8717.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8717.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8717.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8717.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8717.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8717.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15074.26},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13769.16},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8717.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11532.99,"10th_percentile":11532.99,"90th_percentile":11532.99,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":87164.02,"10th_percentile":87164.02,"90th_percentile":87164.02,"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":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11225.41,"10th_percentile":11225.41,"90th_percentile":11225.41,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5724.74,"10th_percentile":5724.74,"90th_percentile":5724.74,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":5976.66,"10th_percentile":5976.66,"90th_percentile":5976.66,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6934.72,"10th_percentile":6934.72,"90th_percentile":6934.72,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Adrenal And Pituitary Procedures With Cc/Mcc","code_information":[{"code":"614","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20333.38,"maximum":39744.55,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30189.54},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20333.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20333.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29387.59},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":30302.46},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31807.74},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20333.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20333.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":34573.63},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20333.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20333.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20333.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20333.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20333.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20333.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20333.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39744.55},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36303.56},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20333.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":16261.04,"10th_percentile":16261.04,"90th_percentile":16261.04,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":16931.19,"10th_percentile":16931.19,"90th_percentile":16931.19,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":50742.8,"10th_percentile":50742.8,"90th_percentile":50742.8,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17078.07,"10th_percentile":17078.07,"90th_percentile":17078.07,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":39154.69,"10th_percentile":39154.69,"90th_percentile":39154.69,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Adrenal And Pituitary Procedures Without Cc/Mcc","code_information":[{"code":"615","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13172.01,"maximum":24991.21,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18983.06},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13172.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13172.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18478.79},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":19054.06},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20000.58},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13172.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13172.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":21739.76},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13172.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13172.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13172.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13172.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13172.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13172.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13172.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24991.21},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22827.53},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13172.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10952.27,"10th_percentile":10952.27,"90th_percentile":10952.27,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":43210.29,"10th_percentile":43210.29,"90th_percentile":46322.16,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11245.17,"10th_percentile":11245.17,"90th_percentile":11245.17,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Mcc","code_information":[{"code":"616","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32040.98,"maximum":67407.72,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51202.2},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32040.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32040.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":49842.06},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":51393.7},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":53946.7},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32040.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32040.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":58637.72},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32040.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32040.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32040.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32040.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32040.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32040.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32040.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67407.72},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":61571.72},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32040.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":48163.08,"10th_percentile":48163.08,"90th_percentile":48163.08,"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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":96633.54,"10th_percentile":96633.54,"90th_percentile":96633.54,"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":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":13090.35,"10th_percentile":13090.35,"90th_percentile":13090.35,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":47853.58,"10th_percentile":47853.58,"90th_percentile":47853.58,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":14414.19,"10th_percentile":14414.19,"90th_percentile":14414.19,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27441.1,"10th_percentile":27441.1,"90th_percentile":27441.1,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc","code_information":[{"code":"617","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17428.16,"maximum":33699.5,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25597.79},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17428.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17428.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24917.81},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":25693.53},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26969.86},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17428.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17428.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":29315.07},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17428.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17428.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17428.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17428.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17428.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17428.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17428.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33699.5},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30781.88},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17428.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13384.84,"10th_percentile":13384.84,"90th_percentile":13384.84,"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":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":59919.91,"10th_percentile":59919.91,"90th_percentile":59919.91,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":53481.92,"10th_percentile":38543.29,"90th_percentile":111826.9,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":19036.3,"10th_percentile":19036.3,"90th_percentile":19036.3,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":53802.14,"10th_percentile":53802.14,"90th_percentile":53802.14,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15013.98,"10th_percentile":15013.98,"90th_percentile":15013.98,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15018.02,"10th_percentile":15018.02,"90th_percentile":15037.42,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":8728.74,"10th_percentile":8728.74,"90th_percentile":13754.43,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":32772.71,"10th_percentile":32772.71,"90th_percentile":32772.71,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13191.23,"10th_percentile":13020.86,"90th_percentile":15071.17,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":13343.7,"maximum":21714.05,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16493.76},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13343.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13343.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16055.62},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":16555.45},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17377.85},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13343.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13343.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":18888.97},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13343.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13343.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13343.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13343.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13343.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13343.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13343.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21714.05},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19834.1},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13343.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures For Obesity With Mcc","code_information":[{"code":"619","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26619.12,"maximum":47551.14,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36119.35},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26619.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26619.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35159.87},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":36254.44},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38055.39},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26619.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26619.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":41364.56},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26619.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26619.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26619.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26619.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26619.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26619.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26619.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47551.14},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43434.28},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26619.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12883.82,"10th_percentile":12883.82,"90th_percentile":12883.82,"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":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":9010.75,"10th_percentile":9010.75,"90th_percentile":9010.75,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures For Obesity Without Cc/Mcc","code_information":[{"code":"621","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14157.88,"maximum":25493.51,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19364.6},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14157.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14157.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18850.2},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":19437.03},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20402.57},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14157.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14157.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":22176.71},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14157.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14157.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14157.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14157.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14157.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14157.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14157.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25493.51},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23286.34},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14157.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19152.75,"10th_percentile":19152.75,"90th_percentile":19152.75,"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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":7609.22,"10th_percentile":7609.22,"90th_percentile":7609.22,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12169.32,"10th_percentile":12169.32,"90th_percentile":12169.32,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":68211.53,"10th_percentile":68211.53,"90th_percentile":68211.53,"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":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"17","median_amount":42762.72,"10th_percentile":37086.16,"90th_percentile":72067.44,"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":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":8017.23,"10th_percentile":7609.22,"90th_percentile":8630.88,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"15","median_amount":44365.4,"10th_percentile":37186.0,"90th_percentile":63809.74,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":12978.35,"10th_percentile":12978.35,"90th_percentile":12978.35},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11495.38,"10th_percentile":11264.31,"90th_percentile":11972.15,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":7609.22,"10th_percentile":6748.5,"90th_percentile":8618.22,"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":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":35841.62,"10th_percentile":35532.0,"90th_percentile":36739.78,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11156.86,"10th_percentile":11156.86,"90th_percentile":11156.86,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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 With Mcc","code_information":[{"code":"622","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32689.79,"maximum":65299.1,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49600.51},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32689.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32689.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":48282.92},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":49786.03},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":52259.16},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32689.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32689.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":56803.44},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32689.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32689.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32689.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32689.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32689.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32689.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32689.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":65299.1},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":59645.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32689.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":133725.76,"10th_percentile":133725.76,"90th_percentile":133725.76,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":16775.48,"10th_percentile":16775.48,"90th_percentile":16775.48,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":28785.99,"10th_percentile":28785.99,"90th_percentile":28785.99,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22429.13,"10th_percentile":22429.13,"90th_percentile":22429.13,"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":"Youthcare","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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":67932.54,"10th_percentile":67932.54,"90th_percentile":67932.54,"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":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":102223.77,"10th_percentile":102223.77,"90th_percentile":102223.77,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13743.49,"10th_percentile":13743.49,"90th_percentile":14298.32,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":5835.21,"10th_percentile":5835.21,"90th_percentile":5835.21,"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":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":29595.11,"10th_percentile":29595.11,"90th_percentile":29595.11,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14366.51,"10th_percentile":14366.51,"90th_percentile":14366.51,"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":"Youthcare","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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Thyroid, Parathyroid And Thyroglossal Procedures With Mcc","code_information":[{"code":"625","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27818.25,"maximum":50001.6,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37980.69},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27818.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27818.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36971.77},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":38122.75},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40016.51},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27818.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27818.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":43496.21},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27818.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27818.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27818.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27818.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27818.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27818.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27818.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50001.6},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":45672.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27818.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":82930.53,"10th_percentile":82930.53,"90th_percentile":82930.53,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Thyroid, Parathyroid And Thyroglossal Procedures With Cc","code_information":[{"code":"626","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14076.55,"maximum":26321.96,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19993.88},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14076.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14076.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19462.76},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":20068.66},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21065.58},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14076.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14076.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":22897.37},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14076.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14076.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14076.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14076.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14076.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14076.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14076.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26321.96},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24043.07},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14076.55,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":84967.22,"10th_percentile":84967.22,"90th_percentile":84967.22,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11634.51,"10th_percentile":11634.51,"90th_percentile":11634.51,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/Mcc","code_information":[{"code":"627","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12530.42,"maximum":22094.26,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16782.57},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12530.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12530.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16336.75},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":16845.34},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17682.13},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12530.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12530.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":19219.71},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12530.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12530.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12530.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12530.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12530.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12530.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12530.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22094.26},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20181.39},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12530.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":54345.65,"10th_percentile":54345.65,"90th_percentile":54345.65,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10018.61,"10th_percentile":10018.61,"90th_percentile":10018.61,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8448.96,"10th_percentile":8448.96,"90th_percentile":8448.96,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":9152.73,"10th_percentile":9152.73,"90th_percentile":9152.73,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9600.74,"10th_percentile":9600.74,"90th_percentile":9600.74,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Mcc","code_information":[{"code":"628","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":34204.3,"maximum":68827.42,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52280.58},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34204.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34204.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":50891.8},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":52476.12},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":55082.89},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34204.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34204.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":59872.71},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34204.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34204.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34204.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34204.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34204.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34204.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34204.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":68827.42},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":62868.51},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34204.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30270.25,"10th_percentile":30270.25,"90th_percentile":30270.25,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":109267.39,"10th_percentile":109267.39,"90th_percentile":109267.39,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":15226.33,"10th_percentile":15226.33,"90th_percentile":15226.33,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","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 Cc","code_information":[{"code":"629","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20215.9,"maximum":39243.99,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29809.32},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20215.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20215.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29017.47},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":29920.82},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31407.14},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20215.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20215.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":34138.2},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20215.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20215.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20215.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20215.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20215.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20215.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20215.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39243.99},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35846.34},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20215.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":76924.59,"10th_percentile":76924.59,"90th_percentile":76924.59,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":80978.35,"10th_percentile":62366.79,"90th_percentile":94062.09,"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":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":63122.41,"10th_percentile":47051.67,"90th_percentile":74835.92,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":38424.24,"10th_percentile":38424.24,"90th_percentile":38424.24,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endocrine, Nutritional And Metabolic O.R. Procedures Without Cc/Mcc","code_information":[{"code":"630","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13716.0,"maximum":24438.33,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18563.1},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13716.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13716.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18069.99},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":18632.53},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19558.1},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13716.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13716.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":21258.81},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13716.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13716.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13716.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13716.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13716.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13716.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13716.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24438.33},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22322.52},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13716.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Diabetes With Mcc","code_information":[{"code":"637","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13509.97,"maximum":25399.33,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19293.06},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13509.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13509.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18780.56},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":19365.22},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20327.2},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13509.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13509.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":22094.78},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13509.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13509.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13509.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13509.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13509.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13509.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13509.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25399.33},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23200.32},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13509.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13682.72,"10th_percentile":13682.72,"90th_percentile":13682.72,"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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":5736.13,"10th_percentile":5736.13,"90th_percentile":5736.13,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11445.7,"10th_percentile":11425.39,"90th_percentile":11609.65,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":45271.35,"10th_percentile":45271.35,"90th_percentile":115844.68,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":49537.75,"10th_percentile":44808.78,"90th_percentile":92681.16,"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":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":5736.13,"10th_percentile":5736.13,"90th_percentile":5738.13,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9355.76,"10th_percentile":9355.76,"90th_percentile":9355.76,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11291.34,"10th_percentile":11291.34,"90th_percentile":11291.34,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":67655.16,"10th_percentile":45005.8,"90th_percentile":106258.78,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":21194.74,"10th_percentile":21194.74,"90th_percentile":21194.74},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":5736.13,"10th_percentile":5736.13,"90th_percentile":5736.13,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11425.45,"10th_percentile":10649.36,"90th_percentile":11441.06,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11574.6,"10th_percentile":11574.6,"90th_percentile":11574.6,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9771.24,"10th_percentile":9771.24,"90th_percentile":9771.24,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":5216.34,"10th_percentile":2616.65,"90th_percentile":5736.13,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10830.34,"10th_percentile":10830.34,"90th_percentile":10830.34,"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 Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":11244.08,"10th_percentile":11244.08,"90th_percentile":11244.08,"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":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":25399.33,"10th_percentile":25399.33,"90th_percentile":25399.33,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"1 through 10","median_amount":22241.52,"10th_percentile":22241.52,"90th_percentile":22241.52,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10321.29,"10th_percentile":6833.18,"90th_percentile":11423.79,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":8625.78,"maximum":15996.89,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12151.07},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8625.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8625.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11828.28},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":12196.51},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12802.38},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8625.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8625.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":13915.63},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8625.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8625.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8625.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8625.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8625.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8625.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8625.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15996.89},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14611.91},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8625.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"13","median_amount":7849.31,"10th_percentile":4609.18,"90th_percentile":11224.73,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":4132.21,"10th_percentile":4132.21,"90th_percentile":7028.64,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6731.64,"10th_percentile":5278.55,"90th_percentile":7435.86,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":40786.86,"10th_percentile":26963.12,"90th_percentile":51898.55,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22947.32,"10th_percentile":20783.52,"90th_percentile":44466.9,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":3945.06,"10th_percentile":1049.87,"90th_percentile":6614.94,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6356.54,"10th_percentile":6356.54,"90th_percentile":6356.54,"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":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"18","median_amount":30092.92,"10th_percentile":17104.51,"90th_percentile":52910.46,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":8245.51,"10th_percentile":8245.51,"90th_percentile":10931.04},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8315.2,"10th_percentile":8315.2,"90th_percentile":8315.2,"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":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":5534.21,"10th_percentile":3945.06,"90th_percentile":10770.15,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"14","median_amount":7336.0,"10th_percentile":1235.41,"90th_percentile":7364.77,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7415.93,"10th_percentile":7415.93,"90th_percentile":7415.93,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7330.22,"10th_percentile":7330.22,"90th_percentile":7330.22,"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":"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":"20","median_amount":3945.06,"10th_percentile":3445.92,"90th_percentile":5835.21,"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":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":3818.0,"10th_percentile":3818.0,"90th_percentile":3818.0,"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":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":15996.89,"10th_percentile":15574.56,"90th_percentile":15996.89,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7330.23,"10th_percentile":4292.75,"90th_percentile":7435.86,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":6140.76,"maximum":10928.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8301.2},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6140.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6140.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8080.68},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":8332.24},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8746.15},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6140.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6140.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":9506.69},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6140.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6140.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6140.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6140.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6140.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6140.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6140.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10928.53},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9982.36},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6140.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8023.53,"10th_percentile":8023.53,"90th_percentile":8023.53,"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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":3598.95,"10th_percentile":3598.95,"90th_percentile":3598.95,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5141.33,"10th_percentile":5141.33,"90th_percentile":5141.33,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":14674.97,"10th_percentile":14674.97,"90th_percentile":27409.5,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24565.49,"10th_percentile":18621.67,"90th_percentile":50848.61,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":3945.06,"10th_percentile":3945.06,"90th_percentile":3945.06,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":23032.21,"10th_percentile":12885.03,"90th_percentile":37903.5,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":15504.25,"10th_percentile":15504.25,"90th_percentile":15504.25},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":3945.06,"10th_percentile":3945.06,"90th_percentile":3945.06,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5217.94,"10th_percentile":5217.94,"90th_percentile":5217.94,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":3945.06,"10th_percentile":3819.51,"90th_percentile":3945.06,"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":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"1 through 10","median_amount":7985.89,"10th_percentile":7985.89,"90th_percentile":7985.89,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4354.82,"10th_percentile":4354.82,"90th_percentile":5129.02,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":12596.39,"maximum":23163.39,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17594.67},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12596.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12596.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17127.28},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":17660.48},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18537.77},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12596.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12596.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":20149.75},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12596.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12596.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12596.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12596.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12596.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12596.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12596.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23163.39},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21157.96},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12596.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":7379.15,"10th_percentile":7379.15,"90th_percentile":7379.15,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10447.93,"10th_percentile":5726.59,"90th_percentile":10457.9,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":24513.12,"10th_percentile":20152.44,"90th_percentile":51226.01,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":45136.49,"10th_percentile":45136.49,"90th_percentile":45136.49,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":6001.27,"10th_percentile":5597.71,"90th_percentile":6254.47,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10441.93,"10th_percentile":10441.93,"90th_percentile":11020.6,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10503.38,"10th_percentile":10503.38,"90th_percentile":10503.38,"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":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":43492.79,"10th_percentile":35336.43,"90th_percentile":61929.8,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":13929.6,"10th_percentile":13929.6,"90th_percentile":16264.77},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10060.02,"10th_percentile":10060.02,"90th_percentile":10060.02,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":10958.17,"10th_percentile":10958.17,"90th_percentile":10958.17,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"26","median_amount":9677.53,"10th_percentile":6301.58,"90th_percentile":10471.05,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8921.17,"10th_percentile":8921.17,"90th_percentile":10185.6,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1839.5,"10th_percentile":1839.5,"90th_percentile":1839.5,"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":"[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":5122.46,"10th_percentile":5122.46,"90th_percentile":5203.58,"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":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8246.25,"10th_percentile":6561.87,"90th_percentile":10228.72,"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":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":8257.63,"10th_percentile":8257.63,"90th_percentile":23161.65,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"1 through 10","median_amount":11753.54,"10th_percentile":11753.54,"90th_percentile":11753.54,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"16","median_amount":8628.27,"10th_percentile":4478.78,"90th_percentile":10473.53,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":7559.48,"maximum":13630.14,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10353.31},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7559.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7559.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10078.29},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":10392.04},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10908.26},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7559.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7559.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11856.81},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7559.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7559.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7559.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7559.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7559.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7559.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7559.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13630.14},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12450.08},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7559.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9948.33,"10th_percentile":9948.33,"90th_percentile":24469.23,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":3120.05,"10th_percentile":1134.56,"90th_percentile":3407.08,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"11","median_amount":6314.5,"10th_percentile":5890.46,"90th_percentile":6501.58,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":645.07,"10th_percentile":645.07,"90th_percentile":645.07,"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":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":25077.4,"10th_percentile":16167.94,"90th_percentile":91301.81,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"11","median_amount":13180.0,"10th_percentile":8991.65,"90th_percentile":29107.14,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":3863.73,"10th_percentile":3444.09,"90th_percentile":4152.61,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6306.96,"10th_percentile":6219.29,"90th_percentile":7117.19,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6112.52,"10th_percentile":6112.52,"90th_percentile":6112.52,"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":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"18","median_amount":23141.01,"10th_percentile":10633.31,"90th_percentile":45866.55,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":7323.91,"10th_percentile":7323.91,"90th_percentile":8488.78},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6083.84,"10th_percentile":6083.84,"90th_percentile":6083.84,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":3107.96,"10th_percentile":2929.97,"90th_percentile":4022.21,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"13","median_amount":6164.86,"10th_percentile":4947.79,"90th_percentile":6366.12,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":5122.46,"10th_percentile":4157.92,"90th_percentile":5203.58,"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":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4489.65,"10th_percentile":4489.65,"90th_percentile":4489.65,"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 Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":3413.23,"10th_percentile":3413.23,"90th_percentile":3413.23,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":13510.15,"10th_percentile":12185.09,"90th_percentile":13628.4,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"1 through 10","median_amount":12448.48,"10th_percentile":12448.48,"90th_percentile":12448.48,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"21","median_amount":6301.58,"10th_percentile":4366.08,"90th_percentile":6329.46,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inborn And Other Disorders Of Metabolism","code_information":[{"code":"642","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13378.04,"maximum":21646.03,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16442.09},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13378.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13378.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16005.32},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":16503.59},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17323.41},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13378.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13378.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":18829.8},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13378.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13378.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13378.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13378.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13378.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13378.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13378.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21646.03},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19771.96},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13378.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":28306.21,"10th_percentile":28306.21,"90th_percentile":33341.74,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":147.09,"10th_percentile":147.09,"90th_percentile":147.09,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9428.71,"10th_percentile":9428.71,"90th_percentile":9428.71,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endocrine Disorders With Mcc","code_information":[{"code":"643","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15402.2,"maximum":28904.97,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21955.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15402.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15402.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21372.67},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":22038.03},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23132.78},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15402.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15402.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":25144.32},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15402.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15402.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15402.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15402.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15402.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15402.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15402.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28904.97},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26402.45},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15402.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":6845.65,"10th_percentile":6845.65,"90th_percentile":6845.65,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8283.48,"10th_percentile":6286.02,"90th_percentile":12946.69,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":49280.95,"10th_percentile":49280.95,"90th_percentile":61938.26,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12457.34,"10th_percentile":12457.34,"90th_percentile":12457.34,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":31733.19,"10th_percentile":15755.62,"90th_percentile":56460.11,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":70495.72,"10th_percentile":70495.72,"90th_percentile":70495.72,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12153.69,"10th_percentile":11598.56,"90th_percentile":19611.16,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11293.78,"10th_percentile":11293.78,"90th_percentile":11293.78,"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":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12936.27,"10th_percentile":12936.27,"90th_percentile":12987.18,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endocrine Disorders With Cc","code_information":[{"code":"644","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9789.67,"maximum":18025.27,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13691.81},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9789.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9789.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13328.1},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":13743.02},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14425.71},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9789.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9789.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":15680.12},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9789.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9789.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9789.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9789.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9789.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9789.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9789.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18025.27},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16464.69},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9789.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13610.17,"10th_percentile":13610.17,"90th_percentile":13610.17,"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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8216.91,"10th_percentile":5000.35,"90th_percentile":8430.26,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":23073.62,"10th_percentile":22591.72,"90th_percentile":68005.67,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9398.27,"10th_percentile":9398.27,"90th_percentile":9398.27,"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":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":4290.84,"10th_percentile":4290.84,"90th_percentile":4290.84,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8434.26,"10th_percentile":8434.26,"90th_percentile":8434.26,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7964.1,"10th_percentile":7964.1,"90th_percentile":7964.1,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":35618.3,"10th_percentile":20968.11,"90th_percentile":50824.32,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":5671.94,"10th_percentile":5671.94,"90th_percentile":5671.94},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7926.01,"10th_percentile":6494.76,"90th_percentile":8430.26,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6959.53,"10th_percentile":6959.53,"90th_percentile":6959.53,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":4730.34,"10th_percentile":4730.34,"90th_percentile":4730.34,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6019.01,"10th_percentile":6019.01,"90th_percentile":6019.01,"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":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":18023.53,"10th_percentile":18023.53,"90th_percentile":18023.53,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"1 through 10","median_amount":13507.44,"10th_percentile":13507.44,"90th_percentile":13507.44,"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":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6387.62,"10th_percentile":4366.08,"90th_percentile":6669.13,"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":"Youthcare","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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":20703.03,"10th_percentile":20703.03,"90th_percentile":20703.03,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":20416.45,"10th_percentile":17021.44,"90th_percentile":28213.7,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":3903.5,"10th_percentile":3903.5,"90th_percentile":3903.5,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5713.18,"10th_percentile":5494.56,"90th_percentile":6257.77,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":164.94,"10th_percentile":164.94,"90th_percentile":164.94,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":12822.1,"10th_percentile":12822.1,"90th_percentile":12822.1,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney Transplant With Hemodialysis With Mcc","code_information":[{"code":"650","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":43011.2,"maximum":80350.69,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61033.54},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43011.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43011.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":59412.24},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":61261.81},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":64305.01},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43011.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43011.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":69896.76},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43011.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43011.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43011.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43011.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43011.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43011.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43011.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":80350.69},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":73394.12},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43011.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney Transplant With Hemodialysis Without Mcc","code_information":[{"code":"651","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":34014.53,"maximum":60558.64,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45999.71},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34014.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34014.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44777.77},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":46171.75},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":48465.35},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34014.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34014.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":52679.73},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34014.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34014.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34014.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34014.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34014.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34014.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34014.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60558.64},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":55315.62},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34014.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney Transplant","code_information":[{"code":"652","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29710.48,"maximum":53564.8,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40687.26},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29710.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29710.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39606.44},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":40839.44},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":42868.15},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29710.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29710.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":46595.82},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29710.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29710.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29710.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29710.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29710.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29710.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29710.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53564.8},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":48927.29},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29710.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Bladder Procedures With Mcc","code_information":[{"code":"653","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":47484.23,"maximum":97219.62,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":73847.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47484.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47484.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":71885.33},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":74123.2},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":77805.3},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47484.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47484.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":84570.98},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47484.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47484.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47484.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47484.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47484.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47484.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47484.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":97219.62},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":88802.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47484.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":366749.34,"10th_percentile":366749.34,"90th_percentile":366749.34,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":115448.88,"10th_percentile":115448.88,"90th_percentile":115448.88,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Bladder Procedures With Cc","code_information":[{"code":"654","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25823.01,"maximum":49216.76,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37384.53},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25823.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25823.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36391.45},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":37524.36},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39388.39},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25823.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25823.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":42813.47},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25823.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25823.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25823.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25823.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25823.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25823.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25823.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49216.76},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44955.69},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25823.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21765.31,"10th_percentile":21765.31,"90th_percentile":21765.31,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":200850.09,"10th_percentile":200850.09,"90th_percentile":200850.09,"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":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":36734.53,"10th_percentile":36734.53,"90th_percentile":36734.53,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21125.37,"10th_percentile":21125.37,"90th_percentile":21125.37,"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":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":185038.84,"10th_percentile":185038.84,"90th_percentile":185038.84,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21778.74,"10th_percentile":21778.74,"90th_percentile":21778.74,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21787.74,"10th_percentile":21787.74,"90th_percentile":21787.74,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Bladder Procedures Without Cc/Mcc","code_information":[{"code":"655","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19653.84,"maximum":36228.45,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27518.75},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19653.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19653.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26787.74},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":27621.67},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28993.79},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19653.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19653.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":31514.99},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19653.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19653.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19653.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19653.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19653.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19653.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19653.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36228.45},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33091.87},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19653.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":119246.14,"10th_percentile":119246.14,"90th_percentile":119246.14,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16859.9,"10th_percentile":16859.9,"90th_percentile":16859.9,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Neoplasm With Mcc","code_information":[{"code":"656","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29297.52,"maximum":56817.55,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43158.01},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29297.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29297.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":42011.56},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":43319.43},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":45471.33},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29297.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29297.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":49425.37},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29297.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29297.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29297.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29297.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29297.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29297.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29297.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56817.55},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":51898.42},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29297.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":41914.62,"10th_percentile":41914.62,"90th_percentile":41914.62,"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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":90623.98,"10th_percentile":90623.98,"90th_percentile":90623.98,"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":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":75908.74,"10th_percentile":75908.74,"90th_percentile":75908.74,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23535.17,"10th_percentile":23535.17,"90th_percentile":23535.17,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Neoplasm With Cc","code_information":[{"code":"657","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17064.0,"maximum":31882.15,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24217.34},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17064.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17064.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23574.03},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":24307.92},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25515.43},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17064.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17064.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":27734.16},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17064.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17064.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17064.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17064.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17064.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17064.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17064.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31882.15},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29121.87},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17064.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11808.05,"10th_percentile":11808.05,"90th_percentile":11808.05,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":49091.64,"10th_percentile":49091.64,"90th_percentile":49091.64,"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":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":93931.95,"10th_percentile":93931.95,"90th_percentile":93931.95,"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":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14276.01,"10th_percentile":14276.01,"90th_percentile":14276.01,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":149204.66,"10th_percentile":149204.66,"90th_percentile":149204.66,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14257.34,"10th_percentile":14257.34,"90th_percentile":14257.34,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":10832.14,"10th_percentile":10832.14,"90th_percentile":10832.14,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"1 through 10","median_amount":29123.46,"10th_percentile":29123.46,"90th_percentile":29123.46,"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":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14244.63,"10th_percentile":14244.63,"90th_percentile":14244.63,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Neoplasm Without Cc/Mcc","code_information":[{"code":"658","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14550.06,"maximum":26229.52,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19923.67},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14550.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14550.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19394.41},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":19998.19},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20991.6},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14550.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14550.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":22816.96},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14550.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14550.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14550.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14550.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14550.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14550.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14550.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26229.52},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23958.63},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14550.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":9327.95,"10th_percentile":9327.95,"90th_percentile":9327.95,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11785.42,"10th_percentile":11785.42,"90th_percentile":11785.42,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12501.27,"10th_percentile":12501.27,"90th_percentile":12501.27,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","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":"1 through 10","median_amount":51105.98,"10th_percentile":51105.98,"90th_percentile":51105.98,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19414.28,"10th_percentile":19414.28,"90th_percentile":19414.28,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":85953.17,"10th_percentile":85953.17,"90th_percentile":85953.17,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":12425.18,"10th_percentile":12425.18,"90th_percentile":12425.18,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20014.73,"10th_percentile":20014.73,"90th_percentile":20014.73,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19958.04,"10th_percentile":19958.04,"90th_percentile":19958.04,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Non-Neoplasm With Cc","code_information":[{"code":"660","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12470.78,"maximum":23369.2,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17751.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12470.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12470.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17279.46},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":17817.39},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18702.47},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12470.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12470.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":20328.78},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12470.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12470.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12470.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12470.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12470.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12470.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12470.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23369.2},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21345.95},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12470.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10542.05,"10th_percentile":10542.05,"90th_percentile":10542.05,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":42295.56,"10th_percentile":37319.59,"90th_percentile":64695.4,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":4296.34,"10th_percentile":4296.34,"90th_percentile":4296.34,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12040.37,"10th_percentile":12040.37,"90th_percentile":12040.37,"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":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"11","median_amount":42545.67,"10th_percentile":30097.87,"90th_percentile":79837.37,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":30392.8,"10th_percentile":30392.8,"90th_percentile":30392.8},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":7969.48,"10th_percentile":7969.48,"90th_percentile":8676.28,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10536.71,"10th_percentile":9318.19,"90th_percentile":10545.95,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9017.17,"10th_percentile":9017.17,"90th_percentile":9017.17,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":4280.76,"10th_percentile":4280.76,"90th_percentile":4280.76,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8334.55,"10th_percentile":8334.55,"90th_percentile":8334.55,"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 Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":9116.22,"10th_percentile":9116.22,"90th_percentile":9116.22,"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":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"12","median_amount":10532.82,"10th_percentile":8337.05,"90th_percentile":10542.05,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Non-Neoplasm Without Cc/Mcc","code_information":[{"code":"661","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9883.65,"maximum":17904.93,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13600.4},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9883.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9883.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13239.12},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":13651.26},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14329.4},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9883.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9883.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":15575.43},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9883.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9883.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9883.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9883.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9883.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9883.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9883.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17904.93},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16354.76},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9883.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12735.42,"10th_percentile":12735.42,"90th_percentile":12735.42,"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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":6137.97,"10th_percentile":6137.97,"90th_percentile":7125.75,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7776.2,"10th_percentile":7776.2,"90th_percentile":7776.2,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":31897.57,"10th_percentile":31897.57,"90th_percentile":43406.13,"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":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":42041.78,"10th_percentile":30944.69,"90th_percentile":43516.75,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":32641.69,"10th_percentile":27887.26,"90th_percentile":52688.47,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":11737.87,"10th_percentile":11737.87,"90th_percentile":11737.87},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":7192.72,"10th_percentile":7192.72,"90th_percentile":7192.72,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":17904.93,"10th_percentile":17904.93,"90th_percentile":17904.93,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"1 through 10","median_amount":12092.62,"10th_percentile":12092.62,"90th_percentile":12092.62,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8081.55,"10th_percentile":8081.55,"90th_percentile":8081.55,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Bladder Procedures With Mcc","code_information":[{"code":"662","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28192.36,"maximum":54405.46,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41325.81},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28192.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28192.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40228.03},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":41480.38},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43540.93},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28192.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28192.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":47327.1},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28192.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28192.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28192.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28192.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28192.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28192.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28192.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54405.46},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":49695.16},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28192.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Bladder Procedures With Cc","code_information":[{"code":"663","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14264.51,"maximum":26637.64,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20233.67},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14264.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14264.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19696.18},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":20309.35},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21318.22},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14264.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14264.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":23171.98},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14264.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14264.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14264.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14264.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14264.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14264.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14264.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26637.64},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24331.42},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14264.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11619.52,"10th_percentile":11619.52,"90th_percentile":11619.52,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section With Sterilization With Mcc","code_information":[{"code":"783","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22712.67,"maximum":32126.32,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24402.82},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22712.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22712.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23754.58},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":24494.09},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25710.84},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22712.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22712.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":27946.57},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22712.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22712.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22712.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22712.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22712.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22712.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22712.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32126.32},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29344.9},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22712.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22698.95,"10th_percentile":22698.95,"90th_percentile":22698.95,"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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14336.05,"10th_percentile":14336.05,"90th_percentile":14336.05,"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":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":85670.04,"10th_percentile":85670.04,"90th_percentile":85670.04,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":61621.07,"10th_percentile":52292.48,"90th_percentile":84096.5,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":6510.47,"10th_percentile":6510.47,"90th_percentile":7657.06,"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":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":13584.8,"10th_percentile":13584.8,"90th_percentile":13584.8,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section With Sterilization With Cc","code_information":[{"code":"784","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10106.85,"maximum":18888.6,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14347.58},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10106.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10106.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13966.45},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":14401.25},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15116.63},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10106.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10106.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":16431.12},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10106.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10106.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10106.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10106.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10106.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10106.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10106.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18888.6},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17253.27},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10106.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14017.67,"10th_percentile":13977.17,"90th_percentile":14018.1,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":10560.03,"10th_percentile":10560.03,"90th_percentile":10560.03,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13907.72,"10th_percentile":13907.72,"90th_percentile":13907.72,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":48723.65,"10th_percentile":41449.54,"90th_percentile":91302.63,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":114688.45,"10th_percentile":44912.42,"90th_percentile":214551.72,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":7168.8,"10th_percentile":7168.8,"90th_percentile":7905.98,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"15","median_amount":36911.1,"10th_percentile":33596.37,"90th_percentile":49671.4,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":13366.46,"10th_percentile":13366.46,"90th_percentile":13366.46},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":10251.07,"10th_percentile":10251.07,"90th_percentile":10251.07,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8388.06,"10th_percentile":8388.06,"90th_percentile":8388.06,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":7224.8,"10th_percentile":7224.8,"90th_percentile":29880.97,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":7869.2,"10th_percentile":7869.2,"90th_percentile":7869.2,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":16731.0,"10th_percentile":16731.0,"90th_percentile":16981.0,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"1 through 10","median_amount":15461.0,"10th_percentile":15461.0,"90th_percentile":15461.0,"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":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6763.32,"10th_percentile":6763.32,"90th_percentile":6763.32,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section With Sterilization Without Cc/Mcc","code_information":[{"code":"785","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9182.42,"maximum":15259.13,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11590.68},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9182.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9182.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11282.78},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11634.03},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12211.95},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9182.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9182.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":13273.86},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9182.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9182.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9182.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9182.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9182.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9182.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9182.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15259.13},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13938.03},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9182.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"11","median_amount":11322.13,"10th_percentile":9669.64,"90th_percentile":12214.71,"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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":6677.28,"10th_percentile":6677.28,"90th_percentile":6677.28,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":42247.49,"10th_percentile":36680.12,"90th_percentile":69168.79,"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":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":36340.87,"10th_percentile":34368.48,"90th_percentile":40441.52,"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":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":5496.97,"10th_percentile":5496.97,"90th_percentile":6677.26,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"33","median_amount":37623.59,"10th_percentile":33138.5,"90th_percentile":44763.6,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":13946.11,"10th_percentile":11782.68,"90th_percentile":19173.23},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"1 through 10","median_amount":5088.46,"10th_percentile":5088.46,"90th_percentile":5088.46,"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":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":16981.0,"10th_percentile":15783.44,"90th_percentile":16981.0,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section Without Sterilization With Mcc","code_information":[{"code":"786","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15432.92,"maximum":28181.17,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21406.12},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15432.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15432.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20837.49},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":21486.18},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22553.51},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15432.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15432.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":24514.69},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15432.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15432.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15432.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15432.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15432.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15432.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15432.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28181.17},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25741.31},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15432.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"11","median_amount":21407.44,"10th_percentile":20608.45,"90th_percentile":23257.51,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient 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":9529.71,"10th_percentile":6959.51,"90th_percentile":10288.11,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"14","median_amount":54498.31,"10th_percentile":45747.82,"90th_percentile":69542.47,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"14","median_amount":46687.33,"10th_percentile":36909.43,"90th_percentile":85051.01,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"70","median_amount":48436.66,"10th_percentile":37826.49,"90th_percentile":84050.47,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":17783.09,"10th_percentile":17248.11,"90th_percentile":21592.04},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"17","median_amount":16958.46,"10th_percentile":14447.65,"90th_percentile":16981.0,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"1 through 10","median_amount":50408.12,"10th_percentile":50408.12,"90th_percentile":50408.12,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section Without Sterilization With Cc","code_information":[{"code":"787","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10619.21,"maximum":18518.85,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14066.73},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10619.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10619.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13693.06},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":14119.34},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14820.72},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10619.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10619.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":16109.48},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10619.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10619.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10619.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10619.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10619.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10619.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10619.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18518.85},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16915.54},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10619.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"33","median_amount":13968.98,"10th_percentile":11331.9,"90th_percentile":14795.37,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":8139.8,"10th_percentile":6843.63,"90th_percentile":9861.89,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11985.47,"10th_percentile":11985.47,"90th_percentile":11985.47,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"24","median_amount":46542.82,"10th_percentile":35153.46,"90th_percentile":55855.66,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"32","median_amount":43803.92,"10th_percentile":31668.96,"90th_percentile":60485.53,"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":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":7449.17,"10th_percentile":6402.66,"90th_percentile":9861.89,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"140","median_amount":45750.91,"10th_percentile":34695.81,"90th_percentile":68093.49,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"22","median_amount":14645.13,"10th_percentile":10529.95,"90th_percentile":18070.4},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":6272.47,"10th_percentile":6272.47,"90th_percentile":8674.12,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"26","median_amount":7456.36,"10th_percentile":5959.93,"90th_percentile":9287.55,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":9192.67,"10th_percentile":9192.67,"90th_percentile":9192.67,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"40","median_amount":16981.0,"10th_percentile":14170.28,"90th_percentile":16981.0,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"1 through 10","median_amount":15511.0,"10th_percentile":14914.0,"90th_percentile":15511.0,"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":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section Without Sterilization Without Cc/Mcc","code_information":[{"code":"788","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9191.46,"maximum":15784.11,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11989.44},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9191.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9191.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11670.95},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":12034.28},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12632.09},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9191.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9191.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":13730.53},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9191.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9191.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9191.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9191.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9191.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9191.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9191.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15784.11},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14417.56},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9191.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"69","median_amount":11985.47,"10th_percentile":9681.57,"90th_percentile":12702.18,"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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient 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":7924.56,"10th_percentile":6035.3,"90th_percentile":10288.11,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"47","median_amount":38979.71,"10th_percentile":30178.24,"90th_percentile":51199.67,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"63","median_amount":37364.88,"10th_percentile":30911.84,"90th_percentile":52208.18,"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":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"31","median_amount":6581.43,"10th_percentile":5393.66,"90th_percentile":8674.12,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"251","median_amount":37546.2,"10th_percentile":29946.87,"90th_percentile":50035.12,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"28","median_amount":12757.97,"10th_percentile":10297.89,"90th_percentile":21008.33},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient 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":6316.0,"10th_percentile":5738.67,"90th_percentile":8073.51,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"48","median_amount":6458.66,"10th_percentile":5393.66,"90th_percentile":8147.28,"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":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":6284.37,"10th_percentile":5325.48,"90th_percentile":15242.49,"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":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"60","median_amount":16981.0,"10th_percentile":14786.57,"90th_percentile":16981.0,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"1 through 10","median_amount":14768.86,"10th_percentile":12408.8,"90th_percentile":15511.0,"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":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neonates, Died Or Transferred To Another Acute Care Facility","code_information":[{"code":"789","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16812.78,"maximum":31440.89,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23882.17},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16812.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16812.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23247.76},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":23971.49},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25162.28},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16812.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16812.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":27350.31},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16812.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16812.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16812.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16812.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16812.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16812.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16812.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31440.89},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28718.81},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16812.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23875.55,"10th_percentile":9598.88,"90th_percentile":23880.84,"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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":14915.5,"10th_percentile":14915.5,"90th_percentile":38370.32,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":1194.0,"10th_percentile":1194.0,"90th_percentile":1194.0,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":474102.23,"10th_percentile":474102.23,"90th_percentile":474102.23,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":69196.66,"10th_percentile":69196.66,"90th_percentile":107513.98,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":15629.6,"10th_percentile":3104.0,"90th_percentile":277436.22,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":40122.91,"10th_percentile":40122.91,"90th_percentile":40122.91},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":54561.73,"10th_percentile":54561.73,"90th_percentile":58806.88,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":283180.11,"10th_percentile":283180.11,"90th_percentile":283180.11,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":42689.03,"10th_percentile":42689.03,"90th_percentile":42689.03,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":105523.69,"10th_percentile":105523.69,"90th_percentile":105523.69,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"1 through 10","median_amount":153908.45,"10th_percentile":153908.45,"90th_percentile":153908.45,"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":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extreme Immaturity Or Respiratory Distress Syndrome, Neonate","code_information":[{"code":"790","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":54235.35,"maximum":103686.75,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":78759.36},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54235.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54235.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":76667.2},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":79053.93},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":82980.96},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54235.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54235.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":90196.71},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54235.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54235.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54235.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54235.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54235.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54235.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54235.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":103686.75},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":94709.8},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54235.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":220649.6,"10th_percentile":114523.36,"90th_percentile":376775.91,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":86999.5,"10th_percentile":86999.5,"90th_percentile":86999.5,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":125138.01,"10th_percentile":98610.98,"90th_percentile":514994.19,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"13","median_amount":133061.61,"10th_percentile":110128.96,"90th_percentile":287443.22,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":78165.76,"10th_percentile":43309.3,"90th_percentile":314968.26,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"37","median_amount":204770.07,"10th_percentile":53769.04,"90th_percentile":613306.03,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":6750.57,"10th_percentile":6750.57,"90th_percentile":65127.32},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":87417.03,"10th_percentile":78647.48,"90th_percentile":111975.04,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":34068.12,"10th_percentile":12125.93,"90th_percentile":143739.3,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":84919.55,"10th_percentile":24930.61,"90th_percentile":406816.0,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"1 through 10","median_amount":78759.38,"10th_percentile":78759.38,"90th_percentile":78759.38,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prematurity With Major Problems","code_information":[{"code":"791","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":37206.2,"maximum":70812.2,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53788.2},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37206.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37206.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":52359.37},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":53989.38},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":56671.32},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37206.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37206.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":61599.27},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37206.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37206.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37206.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37206.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37206.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37206.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37206.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":70812.2},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":64681.45},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37206.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":53773.63,"10th_percentile":43785.56,"90th_percentile":88174.77,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":30695.05,"10th_percentile":30695.05,"90th_percentile":43309.29,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":86574.82,"10th_percentile":73760.72,"90th_percentile":336920.9,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"13","median_amount":100242.64,"10th_percentile":27960.96,"90th_percentile":169964.36,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":9355.06,"10th_percentile":4490.87,"90th_percentile":55315.32,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"30","median_amount":72341.62,"10th_percentile":8858.94,"90th_percentile":153187.55,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":15757.87,"10th_percentile":15757.87,"90th_percentile":15757.87},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":65926.52,"10th_percentile":65926.52,"90th_percentile":65926.52,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":27875.68,"10th_percentile":10985.9,"90th_percentile":44766.05,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":56458.18,"10th_percentile":56458.18,"90th_percentile":56458.18,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":7587.0,"10th_percentile":4200.0,"90th_percentile":59024.0,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"1 through 10","median_amount":31018.0,"10th_percentile":31018.0,"90th_percentile":31018.0,"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":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22113.61,"10th_percentile":22113.61,"90th_percentile":22113.61,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prematurity Without Major Problems","code_information":[{"code":"792","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22659.35,"maximum":42726.96,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32454.95},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22659.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22659.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31592.82},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":32576.34},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34194.58},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22659.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22659.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":37168.02},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22659.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22659.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22659.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22659.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22659.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22659.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22659.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42726.96},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39027.76},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22659.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"21","median_amount":6603.95,"10th_percentile":2384.67,"90th_percentile":32453.63,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":2381.8,"10th_percentile":1415.88,"90th_percentile":19048.45,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1380.78,"10th_percentile":1380.78,"90th_percentile":1380.78,"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":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"23","median_amount":8816.14,"10th_percentile":4553.05,"90th_percentile":106067.53,"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":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"35","median_amount":6874.92,"10th_percentile":3914.73,"90th_percentile":61320.75,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":1415.88,"10th_percentile":876.3,"90th_percentile":20090.58,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"91","median_amount":10288.92,"10th_percentile":5004.41,"90th_percentile":96973.54,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":2158.23,"10th_percentile":867.9,"90th_percentile":4936.47},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":985.14,"10th_percentile":985.14,"90th_percentile":38290.78,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"26","median_amount":1749.74,"10th_percentile":985.13,"90th_percentile":13108.72,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":1310.66,"10th_percentile":1004.83,"90th_percentile":4166.69,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"20","median_amount":2442.0,"10th_percentile":886.0,"90th_percentile":23671.29,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"1 through 10","median_amount":3770.0,"10th_percentile":3770.0,"90th_percentile":13860.0,"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":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Full Term Neonate With Major Problems","code_information":[{"code":"793","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":38205.63,"maximum":72739.43,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55252.11},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38205.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38205.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":53784.39},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":55458.76},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":58213.69},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38205.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38205.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":63275.76},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38205.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38205.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38205.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38205.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38205.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38205.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38205.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":72739.43},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":66441.83},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38205.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"15","median_amount":15176.42,"10th_percentile":4362.82,"90th_percentile":40851.94,"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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":2583.56,"10th_percentile":1449.83,"90th_percentile":14586.99,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":55250.78,"10th_percentile":55250.78,"90th_percentile":55250.78,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"24","median_amount":12312.07,"10th_percentile":4399.42,"90th_percentile":94023.88,"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":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"25","median_amount":7922.78,"10th_percentile":4201.01,"90th_percentile":30042.9,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":10985.91,"10th_percentile":2233.03,"90th_percentile":50709.67,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"71","median_amount":12515.46,"10th_percentile":4707.75,"90th_percentile":74436.02,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":4209.04,"10th_percentile":1496.77,"90th_percentile":26530.79},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":6678.65,"10th_percentile":4372.73,"90th_percentile":25416.18,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"17","median_amount":4458.77,"10th_percentile":1380.78,"90th_percentile":17756.86,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":1004.83,"10th_percentile":1004.83,"90th_percentile":33713.35,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"15","median_amount":4593.0,"10th_percentile":2442.0,"90th_percentile":26019.9,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"1 through 10","median_amount":9240.0,"10th_percentile":9240.0,"90th_percentile":9240.0,"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":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":10872.22,"10th_percentile":10872.22,"90th_percentile":10872.22,"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."}]}]},{"description":"Neonate With Other Significant Problems","code_information":[{"code":"794","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13864.2,"maximum":25746.4,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19556.7},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13864.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13864.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19037.19},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":19629.84},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20604.96},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13864.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13864.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":22396.7},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13864.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13864.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13864.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13864.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13864.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13864.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13864.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25746.4},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23517.34},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13864.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"99","median_amount":4276.48,"10th_percentile":2171.84,"90th_percentile":8953.07,"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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient 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":1449.83,"10th_percentile":985.15,"90th_percentile":4289.25,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"98","median_amount":4863.36,"10th_percentile":3667.26,"90th_percentile":11462.08,"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":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"147","median_amount":4746.07,"10th_percentile":3004.07,"90th_percentile":8869.07,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"73","median_amount":1380.78,"10th_percentile":985.13,"90th_percentile":2829.68,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"502","median_amount":5233.97,"10th_percentile":3262.65,"90th_percentile":9327.12,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"63","median_amount":1942.69,"10th_percentile":1337.33,"90th_percentile":4295.07},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient 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":985.14,"10th_percentile":894.04,"90th_percentile":8590.07,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2460.55,"10th_percentile":2460.55,"90th_percentile":2460.55,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"20","median_amount":1004.83,"10th_percentile":985.14,"90th_percentile":2305.57,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"124","median_amount":2442.0,"10th_percentile":1221.0,"90th_percentile":4956.84,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"20","median_amount":2230.0,"10th_percentile":1115.0,"90th_percentile":8047.9,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"82","median_amount":985.15,"10th_percentile":953.63,"90th_percentile":1253.12,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"174","median_amount":4287.48,"10th_percentile":2517.18,"90th_percentile":6213.07,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"277","median_amount":4345.48,"10th_percentile":2852.48,"90th_percentile":5757.12,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"126","median_amount":985.13,"10th_percentile":894.04,"90th_percentile":985.14,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":662.25,"10th_percentile":662.25,"90th_percentile":662.25,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1068","median_amount":4303.55,"10th_percentile":2798.4,"90th_percentile":5987.99,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"134","median_amount":1535.43,"10th_percentile":1005.69,"90th_percentile":2542.06},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"45","median_amount":985.14,"10th_percentile":894.04,"90th_percentile":1380.78,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"253","median_amount":985.13,"10th_percentile":894.04,"90th_percentile":985.13,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient 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":1004.83,"10th_percentile":911.92,"90th_percentile":1004.83,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"271","median_amount":2410.62,"10th_percentile":1037.85,"90th_percentile":3516.48,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"31","median_amount":2230.0,"10th_percentile":1115.0,"90th_percentile":3216.0,"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":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery With Sterilization And/Or D&C With Mcc","code_information":[{"code":"796","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11072.84,"maximum":22265.18,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16912.4},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11072.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11072.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16463.14},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":16975.65},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17818.92},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11072.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11072.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":19368.4},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11072.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11072.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11072.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11072.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11072.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11072.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11072.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22265.18},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20337.51},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11072.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":33744.42,"10th_percentile":33744.42,"90th_percentile":33744.42,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery With Sterilization And/Or D&C With Cc","code_information":[{"code":"797","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9567.37,"maximum":16886.38,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12826.71},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9567.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9567.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12485.98},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":12874.69},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13514.24},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9567.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9567.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":14689.39},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9567.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9567.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9567.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9567.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9567.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9567.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9567.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16886.38},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15424.39},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9567.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":7137.56,"10th_percentile":7137.56,"90th_percentile":7137.56,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":35169.84,"10th_percentile":35169.84,"90th_percentile":35169.84,"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":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":7369.28,"10th_percentile":7369.28,"90th_percentile":7369.28,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":42363.59,"10th_percentile":42363.59,"90th_percentile":45986.84,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":6453.68,"10th_percentile":6453.68,"90th_percentile":7503.1,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":1187.77,"10th_percentile":1187.77,"90th_percentile":1187.77,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":11771.0,"10th_percentile":11771.0,"90th_percentile":11771.0,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"1 through 10","median_amount":5726.15,"10th_percentile":5726.15,"90th_percentile":5726.15,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery With Sterilization And/Or D&C Without Cc/Mcc","code_information":[{"code":"798","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9176.1,"maximum":16886.38,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12826.71},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9176.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9176.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12485.98},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":12874.69},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13514.24},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9176.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9176.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":14689.39},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9176.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9176.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9176.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9176.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9176.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9176.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9176.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16886.38},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15424.39},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9176.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11772.33,"10th_percentile":11772.33,"90th_percentile":11772.33,"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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":7124.06,"10th_percentile":7067.49,"90th_percentile":7678.35,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":16877.03,"10th_percentile":16877.03,"90th_percentile":16877.03,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":38448.31,"10th_percentile":37023.74,"90th_percentile":40210.78,"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":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":6777.72,"10th_percentile":1187.77,"90th_percentile":7369.28,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":26888.87,"10th_percentile":26888.87,"90th_percentile":44574.63,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":7691.15,"10th_percentile":7691.15,"90th_percentile":7691.15,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"11","median_amount":6574.38,"10th_percentile":5081.94,"90th_percentile":7361.8,"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":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":6885.3,"10th_percentile":6885.3,"90th_percentile":6885.3,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Splenic Procedures With Mcc","code_information":[{"code":"799","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":41452.42,"maximum":82923.23,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62987.62},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41452.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41452.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":61314.41},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":63223.2},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":66363.83},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41452.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41452.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":72134.61},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41452.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41452.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41452.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41452.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41452.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41452.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41452.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":82923.23},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":75743.94},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41452.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":40093.99,"10th_percentile":40093.99,"90th_percentile":40093.99,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Splenic Procedures With Cc","code_information":[{"code":"800","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25914.28,"maximum":50816.1,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38599.37},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25914.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25914.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37574.02},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":38743.74},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40668.35},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25914.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25914.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":44204.73},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25914.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25914.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25914.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25914.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25914.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25914.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25914.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50816.1},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":46416.56},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25914.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Splenic Procedures Without Cc/Mcc","code_information":[{"code":"801","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17776.97,"maximum":28632.89,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21749.24},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17776.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17776.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21171.49},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":21830.59},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22915.03},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17776.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17776.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":24907.64},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17776.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17776.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17776.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17776.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17776.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17776.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17776.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28632.89},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26153.92},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17776.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures Of The Blood And Blood Forming Organs With Mcc","code_information":[{"code":"802","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":36529.37,"maximum":62519.01,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47488.78},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36529.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36529.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":46227.29},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":47666.4},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":50034.24},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36529.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36529.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":54385.05},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36529.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36529.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36529.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36529.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36529.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36529.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36529.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62519.01},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":57106.26},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36529.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":48562.59,"10th_percentile":48562.59,"90th_percentile":48562.59,"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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25736.27,"10th_percentile":25736.27,"90th_percentile":25736.27,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc","code_information":[{"code":"803","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17325.15,"maximum":31043.24,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23580.12},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17325.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17325.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22953.73},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":23668.31},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24844.04},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17325.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17325.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":27004.39},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17325.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17325.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17325.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17325.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17325.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17325.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17325.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31043.24},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28355.59},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17325.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/Mcc","code_information":[{"code":"804","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12780.73,"maximum":19281.03,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14645.66},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12780.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12780.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14256.62},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":14700.44},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15430.69},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12780.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12780.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":16772.49},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12780.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12780.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12780.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12780.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12780.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12780.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12780.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19281.03},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17611.72},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12780.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":66547.48,"10th_percentile":66547.48,"90th_percentile":66547.48,"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":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":9382.22,"10th_percentile":9382.22,"90th_percentile":9382.22,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":6446.8,"10th_percentile":6446.8,"90th_percentile":6446.8,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery Without Sterilization Or D&C With Mcc","code_information":[{"code":"805","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10279.45,"maximum":17404.37,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13220.18},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10279.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10279.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12869.0},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":13269.63},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13928.8},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10279.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10279.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":15140.0},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10279.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10279.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10279.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10279.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10279.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10279.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10279.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17404.37},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15897.54},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10279.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"15","median_amount":11065.9,"10th_percentile":7442.95,"90th_percentile":13221.5,"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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":5235.21,"10th_percentile":4949.97,"90th_percentile":6385.23,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"17","median_amount":22355.19,"10th_percentile":15793.15,"90th_percentile":33259.22,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"15","median_amount":23930.21,"10th_percentile":19213.01,"90th_percentile":29082.22,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient 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":5646.15,"10th_percentile":5042.47,"90th_percentile":6130.28,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"78","median_amount":23100.48,"10th_percentile":18795.22,"90th_percentile":34458.29,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"15","median_amount":8296.1,"10th_percentile":7194.97,"90th_percentile":12891.74},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":5185.74,"10th_percentile":5185.74,"90th_percentile":5185.74,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"29","median_amount":5042.47,"10th_percentile":4631.45,"90th_percentile":8800.48,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":5737.97,"10th_percentile":4731.41,"90th_percentile":6260.52,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"20","median_amount":12330.0,"10th_percentile":9864.0,"90th_percentile":12330.0,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"1 through 10","median_amount":10829.0,"10th_percentile":10829.0,"90th_percentile":16256.7,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery Without Sterilization Or D&C With Cc","code_information":[{"code":"806","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7340.8,"maximum":12618.56,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9584.93},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7340.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7340.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9330.31},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":9620.78},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10098.69},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7340.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7340.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10976.84},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7340.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7340.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7340.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7340.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7340.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7340.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7340.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12618.56},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11526.08},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7340.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"48","median_amount":9202.8,"10th_percentile":7176.51,"90th_percentile":9889.74,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient 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":4885.21,"10th_percentile":3854.71,"90th_percentile":5235.21,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"27","median_amount":21012.86,"10th_percentile":17470.83,"90th_percentile":26830.81,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"47","median_amount":20301.25,"10th_percentile":15012.76,"90th_percentile":26797.49,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"1 through 10","median_amount":15176.54,"10th_percentile":15176.54,"90th_percentile":15176.54,"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":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"38","median_amount":5034.99,"10th_percentile":3854.7,"90th_percentile":5042.47,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"205","median_amount":20626.32,"10th_percentile":15362.03,"90th_percentile":28149.63,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"32","median_amount":7036.52,"10th_percentile":5529.89,"90th_percentile":8174.43},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient 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":4733.5,"10th_percentile":4342.01,"90th_percentile":6735.76,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"63","median_amount":4949.99,"10th_percentile":3854.7,"90th_percentile":5042.47,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient 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":5135.69,"10th_percentile":4462.12,"90th_percentile":5176.25,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"50","median_amount":12330.0,"10th_percentile":9864.0,"90th_percentile":12330.0,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"1 through 10","median_amount":11262.0,"10th_percentile":8525.05,"90th_percentile":73904.0,"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":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5094.11,"10th_percentile":5094.11,"90th_percentile":5094.11,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc","code_information":[{"code":"807","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6619.69,"maximum":11113.41,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8441.63},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6619.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6619.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8217.38},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":8473.2},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8894.11},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6619.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6619.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":9667.51},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6619.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6619.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6619.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6619.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6619.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6619.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6619.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11113.41},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10151.23},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6619.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"233","median_amount":8442.95,"10th_percentile":6499.21,"90th_percentile":8931.8,"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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"85","median_amount":4492.78,"10th_percentile":3498.28,"90th_percentile":5235.21,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7641.06,"10th_percentile":7641.06,"90th_percentile":7641.06,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"161","median_amount":19159.15,"10th_percentile":14133.92,"90th_percentile":24972.43,"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":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"285","median_amount":19037.61,"10th_percentile":14597.87,"90th_percentile":23548.3,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"134","median_amount":4367.14,"10th_percentile":3854.7,"90th_percentile":5042.47,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"943","median_amount":19283.29,"10th_percentile":14516.06,"90th_percentile":24026.51,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"147","median_amount":6852.71,"10th_percentile":4895.14,"90th_percentile":8559.97},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient 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":4579.65,"10th_percentile":3498.28,"90th_percentile":5360.34,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"36","median_amount":4462.12,"10th_percentile":3568.25,"90th_percentile":5143.32,"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":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"244","median_amount":12330.0,"10th_percentile":9744.0,"90th_percentile":12330.0,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"38","median_amount":10839.67,"10th_percentile":8762.0,"90th_percentile":11262.0,"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":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":135979.71,"10th_percentile":135979.71,"90th_percentile":135979.71,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":38507.98,"10th_percentile":26234.75,"90th_percentile":39945.12,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17746.84,"10th_percentile":17746.84,"90th_percentile":17746.84,"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":"Youthcare","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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":13987.71,"10th_percentile":13987.71,"90th_percentile":13987.71,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9779.31,"10th_percentile":9779.31,"90th_percentile":10290.1,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":61536.74,"10th_percentile":61536.74,"90th_percentile":61536.74,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":31207.78,"10th_percentile":17167.35,"90th_percentile":52451.2,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":4328.74,"10th_percentile":4328.74,"90th_percentile":4328.74,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":32168.5,"10th_percentile":30665.1,"90th_percentile":54440.5,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":10880.74,"10th_percentile":10880.74,"90th_percentile":10880.74,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":21600.68,"10th_percentile":21600.68,"90th_percentile":22078.56,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9772.53,"10th_percentile":7945.17,"90th_percentile":9772.53,"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":"Youthcare","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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":4995.67,"10th_percentile":4995.67,"90th_percentile":4995.67,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":16971.73,"10th_percentile":16971.73,"90th_percentile":16971.73,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":13217.19,"maximum":24536.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18637.29},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13217.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13217.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18142.21},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":18706.99},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19636.27},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13217.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13217.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":21343.77},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13217.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13217.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13217.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13217.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13217.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13217.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13217.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24536.0},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22411.73},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13217.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18038.21,"10th_percentile":18038.21,"90th_percentile":18638.61,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":11562.18,"10th_percentile":11562.18,"90th_percentile":11562.18,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12540.7,"10th_percentile":12540.7,"90th_percentile":12540.7,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":307921.66,"10th_percentile":307921.66,"90th_percentile":307921.66,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10717.77,"10th_percentile":10717.77,"90th_percentile":10717.77,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":40915.16,"10th_percentile":23757.77,"90th_percentile":78563.56,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":20789.32,"10th_percentile":20789.32,"90th_percentile":20789.32},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10529.96,"10th_percentile":10529.96,"90th_percentile":10529.96,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":6549.24,"10th_percentile":6549.24,"90th_percentile":6549.24,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9701.86,"10th_percentile":503.4,"90th_percentile":11089.92,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":5957.67,"10th_percentile":5957.67,"90th_percentile":7707.89,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11039.57,"10th_percentile":10956.75,"90th_percentile":11048.41,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":8824.58,"maximum":16096.3,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12226.58},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8824.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8824.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11901.79},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":12272.31},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12881.94},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8824.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8824.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":14002.11},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8824.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8824.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8824.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8824.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8824.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8824.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8824.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16096.3},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14702.72},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8824.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12048.58,"10th_percentile":2949.82,"90th_percentile":24610.45,"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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":4978.53,"10th_percentile":4787.77,"90th_percentile":6798.91,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6273.46,"10th_percentile":5315.4,"90th_percentile":7393.65,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":34202.76,"10th_percentile":34202.76,"90th_percentile":34202.76,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23069.65,"10th_percentile":16279.74,"90th_percentile":65809.8,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":4865.08,"10th_percentile":4865.08,"90th_percentile":4865.08,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7398.99,"10th_percentile":7392.59,"90th_percentile":7530.36,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7152.19,"10th_percentile":7152.19,"90th_percentile":7152.19,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":36763.28,"10th_percentile":14792.18,"90th_percentile":86052.56,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":4857.15,"10th_percentile":4857.15,"90th_percentile":4857.15},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7684.81,"10th_percentile":7684.81,"90th_percentile":7684.81,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":3423.75,"10th_percentile":3423.75,"90th_percentile":3423.75,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6268.56,"10th_percentile":716.28,"90th_percentile":7605.71,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"17","median_amount":4302.56,"10th_percentile":3687.8,"90th_percentile":5823.59,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5199.77,"10th_percentile":5199.77,"90th_percentile":6875.77,"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":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":4596.32,"10th_percentile":361.5,"90th_percentile":5940.07,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":16096.3,"10th_percentile":16096.3,"90th_percentile":35439.29,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"12","median_amount":7385.76,"10th_percentile":6270.9,"90th_percentile":7605.71,"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":"Youthcare","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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12119.02,"10th_percentile":12119.02,"90th_percentile":12292.8,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":36039.43,"10th_percentile":26529.11,"90th_percentile":36109.52,"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":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":15507.86,"10th_percentile":15507.86,"90th_percentile":15507.86,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":49623.42,"10th_percentile":20735.51,"90th_percentile":116228.6,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":8411.61,"10th_percentile":8411.61,"90th_percentile":8411.61,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12108.57,"10th_percentile":11804.73,"90th_percentile":29404.69,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12248.98,"10th_percentile":12248.98,"90th_percentile":12248.98,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":4207.27,"10th_percentile":4207.27,"90th_percentile":4207.27,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9871.45,"10th_percentile":9871.45,"90th_percentile":9871.45,"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 Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"1 through 10","median_amount":24661.19,"10th_percentile":24661.19,"90th_percentile":24661.19,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12119.02,"10th_percentile":12108.37,"90th_percentile":12292.8,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Reticuloendothelial And Immunity Disorders With Mcc","code_information":[{"code":"814","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19745.11,"maximum":36456.92,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27692.29},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19745.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19745.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26956.68},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":27795.87},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29176.64},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19745.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19745.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":31713.74},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19745.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19745.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19745.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19745.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19745.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19745.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19745.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36456.92},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33300.57},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19745.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":2636.43,"10th_percentile":2636.43,"90th_percentile":2636.43,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16239.83,"10th_percentile":16239.83,"90th_percentile":16239.83,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":36460.41,"10th_percentile":36460.41,"90th_percentile":36460.41,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16249.25,"10th_percentile":16249.25,"90th_percentile":16249.25,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Reticuloendothelial And Immunity Disorders With Cc","code_information":[{"code":"815","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9690.27,"maximum":17721.8,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13461.29},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9690.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9690.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13103.71},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":13511.64},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14182.84},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9690.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9690.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":15416.13},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9690.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9690.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9690.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9690.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9690.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9690.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9690.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17721.8},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16187.49},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9690.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":7599.71,"10th_percentile":7599.71,"90th_percentile":7599.71,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":26765.33,"10th_percentile":26765.33,"90th_percentile":26765.33,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":38166.79,"10th_percentile":38166.79,"90th_percentile":71078.54,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":673.12,"10th_percentile":673.12,"90th_percentile":673.12,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":285.37,"10th_percentile":285.37,"90th_percentile":285.37,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Reticuloendothelial And Immunity Disorders Without Cc/Mcc","code_information":[{"code":"816","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6238.35,"maximum":11500.6,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8735.73},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6238.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6238.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8503.68},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":8768.4},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9203.98},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6238.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6238.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10004.32},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6238.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6238.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6238.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6238.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6238.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6238.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6238.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11500.6},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10504.9},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6238.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":56261.35,"10th_percentile":56261.35,"90th_percentile":56261.35,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":5590.76,"10th_percentile":5590.76,"90th_percentile":5590.76,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":47758.98,"10th_percentile":47758.98,"90th_percentile":47758.98,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":26847.08,"10th_percentile":26847.08,"90th_percentile":26847.08},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":5579.83,"10th_percentile":5579.83,"90th_percentile":5579.83,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses With O.R. Procedures Without Cc/Mcc","code_information":[{"code":"819","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8297.76,"maximum":14240.58,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10816.99},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8297.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8297.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10529.65},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":10857.45},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11396.8},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8297.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8297.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":12387.82},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8297.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8297.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8297.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8297.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8297.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8297.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8297.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14240.58},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13007.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8297.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":6702.1,"10th_percentile":6702.1,"90th_percentile":6702.1,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":6702.1,"10th_percentile":6702.1,"90th_percentile":6702.1,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":19957.47,"10th_percentile":19957.47,"90th_percentile":19957.47,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Leukemia With Major O.R. Procedures With Mcc","code_information":[{"code":"820","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":53524.18,"maximum":101539.76,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":77128.53},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53524.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53524.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":75079.69},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":77417.01},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":81262.72},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53524.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53524.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":88329.05},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53524.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53524.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53524.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53524.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53524.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53524.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53524.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":101539.76},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":92748.69},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53524.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":44484.95,"10th_percentile":44484.95,"90th_percentile":44484.95,"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":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Leukemia With Major 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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":67337.5,"10th_percentile":67337.5,"90th_percentile":67337.5,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":136349.33,"10th_percentile":136349.33,"90th_percentile":136349.33,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":12838.46,"10th_percentile":12838.46,"90th_percentile":12838.46,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"1 through 10","median_amount":35564.36,"10th_percentile":35564.36,"90th_percentile":35564.36,"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":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17309.65,"10th_percentile":17309.65,"90th_percentile":17309.65,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Leukemia With Major O.R. Procedures Without Cc/Mcc","code_information":[{"code":"822","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11407.19,"maximum":19945.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15150.41},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11407.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11407.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14747.96},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":15207.08},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15962.49},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11407.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11407.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":17350.54},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11407.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11407.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11407.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11407.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11407.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11407.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11407.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19945.53},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18218.69},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11407.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Other Procedures With Mcc","code_information":[{"code":"823","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":41957.55,"maximum":81609.93,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61990.04},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41957.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41957.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":60343.34},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":62221.9},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":65312.79},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41957.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41957.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":70992.17},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41957.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41957.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41957.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41957.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41957.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41957.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41957.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":81609.93},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":74544.34},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41957.55,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":35913.52,"10th_percentile":35913.52,"90th_percentile":35913.52,"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":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":97021.03,"10th_percentile":97021.03,"90th_percentile":97021.03,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Other Procedures With Cc","code_information":[{"code":"824","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21000.27,"maximum":38357.99,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29136.33},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21000.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21000.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28362.35},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":29245.3},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30698.07},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21000.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21000.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":33367.47},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21000.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21000.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21000.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21000.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21000.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21000.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21000.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38357.99},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35037.05},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21000.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17057.68,"10th_percentile":17057.68,"90th_percentile":17057.68,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":155940.78,"10th_percentile":155940.78,"90th_percentile":155940.78,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17114.18,"10th_percentile":17114.18,"90th_percentile":17497.23,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":17782.87,"10th_percentile":17782.87,"90th_percentile":17782.87,"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":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/Mcc","code_information":[{"code":"825","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12721.09,"maximum":21464.64,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16304.31},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12721.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12721.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15871.21},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":16365.29},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17178.25},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12721.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12721.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":18672.01},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12721.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12721.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12721.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12721.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12721.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12721.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12721.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21464.64},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19606.28},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12721.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Mcc","code_information":[{"code":"826","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":42797.94,"maximum":83284.26,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":63261.85},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42797.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42797.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":61581.36},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":63498.46},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":66652.77},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42797.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42797.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":72448.67},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42797.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42797.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42797.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42797.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42797.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42797.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42797.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":83284.26},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":76073.71},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42797.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":177222.51,"10th_percentile":177222.51,"90th_percentile":177222.51,"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":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":168872.56,"10th_percentile":168872.56,"90th_percentile":168872.56,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":35862.64,"10th_percentile":35862.64,"90th_percentile":35862.64,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major 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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":60688.11,"10th_percentile":60688.11,"90th_percentile":60688.11,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":132520.2,"10th_percentile":132520.2,"90th_percentile":132520.2,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":41512.48,"10th_percentile":41512.48,"90th_percentile":41512.48},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without C","code_information":[{"code":"828","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15923.6,"maximum":27954.43,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21233.89},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15923.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15923.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20669.84},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":21313.31},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22372.06},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15923.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15923.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":24317.46},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15923.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15923.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15923.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15923.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15923.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15923.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15923.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27954.43},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25534.21},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15923.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":42441.5,"10th_percentile":42441.5,"90th_percentile":42441.5,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":27956.18,"10th_percentile":27956.18,"90th_percentile":27956.18,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12524.2,"10th_percentile":12524.2,"90th_percentile":12524.2,"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":"Youthcare","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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":65764.13,"10th_percentile":65764.13,"90th_percentile":65764.13,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23762.83,"10th_percentile":23762.83,"90th_percentile":23762.83,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":13891.97,"10th_percentile":13891.97,"90th_percentile":13891.97,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/Mcc","code_information":[{"code":"830","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14127.16,"maximum":25505.72,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19373.88},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14127.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14127.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18859.23},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":19446.34},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20412.34},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14127.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14127.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":22187.33},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14127.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14127.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14127.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14127.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14127.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14127.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14127.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25505.72},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23297.49},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14127.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":68232.44,"10th_percentile":68232.44,"90th_percentile":68232.44,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses Without 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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":27857.47,"10th_percentile":27857.47,"90th_percentile":34230.3,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26612.72,"10th_percentile":22444.78,"90th_percentile":26857.19,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":37171.87,"10th_percentile":13005.3,"90th_percentile":108732.25,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":4666.12,"10th_percentile":4666.12,"90th_percentile":4666.12},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":10832.14,"10th_percentile":10832.14,"90th_percentile":10832.14,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6890.88,"10th_percentile":6890.88,"90th_percentile":6890.88,"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 Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":4362.87,"10th_percentile":4362.87,"90th_percentile":4362.87,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":4554.78,"10th_percentile":4554.78,"90th_percentile":4554.78,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":4277.32,"10th_percentile":4277.32,"90th_percentile":4277.32,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4401.53,"10th_percentile":4401.53,"90th_percentile":4401.53,"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":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":93594.25,"10th_percentile":93594.25,"90th_percentile":93594.25,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":46328.56,"10th_percentile":13178.15,"90th_percentile":60473.33,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"11","median_amount":19241.63,"10th_percentile":8648.84,"90th_percentile":29611.18,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":12632.19,"10th_percentile":12632.19,"90th_percentile":12632.19},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":3375.79,"10th_percentile":1457.0,"90th_percentile":3953.12,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4331.96,"10th_percentile":4331.96,"90th_percentile":4331.96,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"1 through 10","median_amount":3135.8,"10th_percentile":3135.8,"90th_percentile":4362.87,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":11538.12,"10th_percentile":10255.45,"90th_percentile":13035.4,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":4122.52,"10th_percentile":3492.88,"90th_percentile":4254.6,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":20004.01,"10th_percentile":20004.01,"90th_percentile":24037.96,"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":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14102.26,"10th_percentile":8561.44,"90th_percentile":16990.87,"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":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"29","median_amount":9529.92,"10th_percentile":5722.48,"90th_percentile":31470.93,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":7330.79,"10th_percentile":2960.31,"90th_percentile":7561.85},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":3633.77,"10th_percentile":3633.77,"90th_percentile":3633.77,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":167.0,"10th_percentile":167.0,"90th_percentile":167.0,"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":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":1009.0,"10th_percentile":1009.0,"90th_percentile":1009.0,"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":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":7715.02,"10th_percentile":6212.11,"90th_percentile":9065.83,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Leukemia With Mcc","code_information":[{"code":"834","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":50136.43,"maximum":96394.66,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":73220.37},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50136.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50136.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":71275.34},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":73494.23},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":77145.08},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50136.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50136.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":83853.35},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50136.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50136.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50136.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50136.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50136.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50136.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50136.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":96394.66},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":88049.04},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50136.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":248128.25,"10th_percentile":248128.25,"90th_percentile":248128.25,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":138455.06,"10th_percentile":138455.06,"90th_percentile":138455.06,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":272083.1,"10th_percentile":272083.1,"90th_percentile":272083.1,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":69454.94,"10th_percentile":69454.94,"90th_percentile":69454.94,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":35756.06,"10th_percentile":35756.06,"90th_percentile":35756.06,"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":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":40352.97,"10th_percentile":40352.97,"90th_percentile":40352.97,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Leukemia With Cc","code_information":[{"code":"835","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19375.52,"maximum":37250.49,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28295.08},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19375.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19375.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27543.45},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":28400.91},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29811.73},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19375.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19375.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":32404.06},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19375.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19375.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19375.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19375.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19375.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19375.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19375.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37250.49},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34025.43},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19375.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2195.72,"10th_percentile":2195.72,"90th_percentile":2195.72,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14797.3,"10th_percentile":14797.3,"90th_percentile":14797.3,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Leukemia Without Cc/Mcc","code_information":[{"code":"836","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11547.26,"maximum":22162.28,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16834.23},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11547.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11547.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16387.05},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":16897.2},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17736.57},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11547.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11547.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":19278.88},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11547.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11547.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11547.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11547.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11547.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11547.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11547.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22162.28},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20243.52},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11547.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":27165.53,"10th_percentile":27165.53,"90th_percentile":27165.53,"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":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemotherapy Agent With Mc","code_information":[{"code":"837","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":43941.05,"maximum":87323.6,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66330.09},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43941.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43941.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":64568.09},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":66578.17},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":69885.47},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43941.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43941.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":75962.47},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43941.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43941.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43941.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43941.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43941.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43941.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43941.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":87323.6},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":79763.33},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43941.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":27193.72,"10th_percentile":27193.72,"90th_percentile":145159.64,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":35750.19,"10th_percentile":35750.19,"90th_percentile":35750.19,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":34801.38,"10th_percentile":34801.38,"90th_percentile":34801.38,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":38165.28,"10th_percentile":38165.28,"90th_percentile":38165.28,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent","code_information":[{"code":"838","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19389.97,"maximum":35372.09,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26868.27},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19389.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19389.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26154.54},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":26968.76},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28308.44},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19389.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19389.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":30770.05},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19389.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19389.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19389.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19389.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19389.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19389.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19389.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35372.09},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32309.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19389.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":68977.3,"10th_percentile":68977.3,"90th_percentile":129642.58,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":35373.84,"10th_percentile":35373.84,"90th_percentile":35373.84,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/Mcc","code_information":[{"code":"839","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13575.03,"maximum":23899.4,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18153.73},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13575.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13575.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17671.5},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":18221.63},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19126.8},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13575.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13575.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":20790.0},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13575.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13575.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13575.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13575.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13575.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13575.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13575.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23899.4},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21830.25},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13575.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18855.52,"10th_percentile":18855.52,"90th_percentile":18855.52,"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":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":93070.44,"10th_percentile":93070.44,"90th_percentile":93070.44,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":6236.59,"10th_percentile":6236.59,"90th_percentile":6236.59},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":6814.98,"10th_percentile":6814.98,"90th_percentile":6814.98,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Mcc","code_information":[{"code":"840","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29759.28,"maximum":55626.33,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42253.17},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29759.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29759.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41130.76},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":42411.21},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44518.0},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29759.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29759.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":48389.13},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29759.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29759.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29759.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29759.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29759.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29759.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29759.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55626.33},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":50810.33},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29759.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24538.46,"10th_percentile":24538.46,"90th_percentile":24588.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27899.73,"10th_percentile":27899.73,"90th_percentile":27899.73,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23316.08,"10th_percentile":23316.08,"90th_percentile":23316.08,"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":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":197800.6,"10th_percentile":197800.6,"90th_percentile":197800.6,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":10240.81,"10th_percentile":10240.81,"90th_percentile":10240.81,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23411.91,"10th_percentile":18057.95,"90th_percentile":25491.68,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":12403.61,"10th_percentile":12403.61,"90th_percentile":12403.61,"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":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"1 through 10","median_amount":50803.96,"10th_percentile":50803.96,"90th_percentile":50803.96,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21828.77,"10th_percentile":21828.77,"90th_percentile":21828.77,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Cc","code_information":[{"code":"841","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15269.36,"maximum":27345.74,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20771.54},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15269.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15269.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20219.76},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":20849.23},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21884.92},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15269.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15269.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":23787.96},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15269.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15269.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15269.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15269.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15269.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15269.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15269.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27345.74},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24978.21},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15269.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":27974.23,"10th_percentile":27974.23,"90th_percentile":27974.23,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":39847.87,"10th_percentile":39847.87,"90th_percentile":39847.87,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":7773.29,"10th_percentile":7773.29,"90th_percentile":7773.29,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":23024.51,"10th_percentile":23024.51,"90th_percentile":23024.51,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia Without Cc/Mcc","code_information":[{"code":"842","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9657.74,"maximum":18344.44,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13934.25},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9657.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9657.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13564.1},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":13986.36},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14681.14},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9657.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9657.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":15957.76},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9657.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9657.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9657.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9657.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9657.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9657.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9657.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18344.44},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16756.23},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9657.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":45706.57,"10th_percentile":45706.57,"90th_percentile":45706.57,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":1726.56,"10th_percentile":1726.56,"90th_percentile":1726.56},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2845.02,"10th_percentile":2845.02,"90th_percentile":2845.02,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":6173.53,"10th_percentile":6173.53,"90th_percentile":6173.53,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Mcc","code_information":[{"code":"843","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18553.2,"maximum":33017.56,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25079.79},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18553.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18553.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24413.57},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":25173.59},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26424.1},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18553.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18553.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":28721.85},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18553.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18553.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18553.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18553.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18553.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18553.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18553.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33017.56},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30158.98},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18553.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12552.26,"10th_percentile":12552.26,"90th_percentile":12552.26,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14756.05,"10th_percentile":14756.05,"90th_percentile":14756.05,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc","code_information":[{"code":"844","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11528.28,"maximum":20843.74,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15832.68},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11528.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11528.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15412.11},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":15891.9},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16681.34},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11528.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11528.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":18131.89},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11528.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11528.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11528.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11528.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11528.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11528.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11528.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20843.74},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19039.14},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11528.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9437.21,"10th_percentile":9437.21,"90th_percentile":9437.21,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7797.36,"10th_percentile":7797.36,"90th_percentile":7797.36,"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":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":14594.63,"10th_percentile":14594.63,"90th_percentile":14594.63,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses Without Cc/Mcc","code_information":[{"code":"845","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8222.75,"maximum":14592.88,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11084.6},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8222.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8222.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10790.15},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11126.06},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11678.75},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8222.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8222.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":12694.3},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8222.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8222.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8222.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8222.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8222.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8222.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8222.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14592.88},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13329.47},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8222.75,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":47722.06,"10th_percentile":17985.44,"90th_percentile":196073.77,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10019.61,"10th_percentile":10019.61,"90th_percentile":10019.61,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":22162.28,"10th_percentile":22162.28,"90th_percentile":22162.28,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"1 through 10","median_amount":20243.52,"10th_percentile":20243.52,"90th_percentile":20243.52,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/Mcc","code_information":[{"code":"848","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8202.87,"maximum":14282.43,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10848.79},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8202.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8202.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10560.6},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":10889.36},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11430.3},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8202.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8202.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":12424.24},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8202.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8202.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8202.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8202.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8202.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8202.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8202.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14282.43},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13045.9},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8202.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10848.79,"10th_percentile":10848.79,"90th_percentile":10848.79,"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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Radiotherapy","code_information":[{"code":"849","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25011.54,"maximum":46583.17,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35384.08},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25011.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25011.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34444.14},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":35516.43},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37280.72},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25011.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25011.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":40522.52},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25011.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25011.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25011.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25011.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25011.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25011.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25011.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46583.17},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":42550.11},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25011.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22461.68,"10th_percentile":22461.68,"90th_percentile":22461.68,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infectious And Parasitic Diseases With O.R. Procedures With Mcc","code_information":[{"code":"853","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":45154.64,"maximum":87231.16,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66259.87},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45154.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45154.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":64499.74},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":66507.7},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":69811.49},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45154.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45154.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":75882.06},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45154.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45154.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45154.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45154.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45154.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45154.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45154.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":87231.16},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":79678.9},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45154.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":62475.28,"10th_percentile":62475.28,"90th_percentile":66257.22,"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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":28811.42,"10th_percentile":20157.14,"90th_percentile":30774.92,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":38266.11,"10th_percentile":28032.4,"90th_percentile":81311.87,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":36623.59,"10th_percentile":36623.59,"90th_percentile":36623.59,"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":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":17021.37,"10th_percentile":17021.37,"90th_percentile":17021.37,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":38645.0,"10th_percentile":38313.11,"90th_percentile":125365.13,"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":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"14","median_amount":103976.12,"10th_percentile":82542.5,"90th_percentile":228990.02,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":40884.48,"10th_percentile":40884.48,"90th_percentile":40884.48},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26478.48,"10th_percentile":26478.48,"90th_percentile":26478.48,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":29792.62,"10th_percentile":730.29,"90th_percentile":54994.26,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"14","median_amount":37038.32,"10th_percentile":16214.42,"90th_percentile":97897.86,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":42125.18,"10th_percentile":42125.18,"90th_percentile":42125.18,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":16291.08,"10th_percentile":4932.81,"90th_percentile":30774.92,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":35637.18,"10th_percentile":35637.18,"90th_percentile":35637.18,"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 Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":63439.02,"10th_percentile":60289.13,"90th_percentile":87227.67,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"1 through 10","median_amount":79975.71,"10th_percentile":79975.71,"90th_percentile":79975.71,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"15","median_amount":38266.1,"10th_percentile":28009.29,"90th_percentile":85244.01,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":17021.37,"10th_percentile":17021.37,"90th_percentile":17021.37,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14361.59,"10th_percentile":12522.73,"90th_percentile":15887.61,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":56974.09,"10th_percentile":56974.09,"90th_percentile":56974.09,"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":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":60003.94,"10th_percentile":43142.9,"90th_percentile":103821.74,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":5668.59,"10th_percentile":5668.59,"90th_percentile":5668.59,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":82882.73,"10th_percentile":38222.6,"90th_percentile":96215.14,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":16472.19,"10th_percentile":16472.19,"90th_percentile":16472.19,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12303.03,"10th_percentile":9598.75,"90th_percentile":15943.03,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9013.1,"10th_percentile":9013.1,"90th_percentile":9013.1,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":6547.4,"10th_percentile":6547.4,"90th_percentile":6547.4,"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":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":30608.96,"10th_percentile":30608.96,"90th_percentile":30608.96,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10542.05,"10th_percentile":10542.05,"90th_percentile":11752.91,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postoperative Or Post-Traumatic Infections With O.R. Procedures With Mcc","code_information":[{"code":"856","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":41631.34,"maximum":78681.58,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59765.7},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41631.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41631.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":58178.09},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":59989.24},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":62969.22},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41631.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41631.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":68444.81},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41631.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41631.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41631.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41631.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41631.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41631.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41631.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":78681.58},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":71869.52},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41631.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":33815.19,"10th_percentile":33815.19,"90th_percentile":33815.19,"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":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":34153.6,"10th_percentile":34153.6,"90th_percentile":34153.6,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":122203.57,"10th_percentile":122203.57,"90th_percentile":126592.33,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":7989.73,"10th_percentile":7989.73,"90th_percentile":7989.73,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":42092.0,"10th_percentile":42092.0,"90th_percentile":42092.0,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":34587.84,"10th_percentile":34587.84,"90th_percentile":72808.3,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc","code_information":[{"code":"857","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19878.84,"maximum":38002.19,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28866.07},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19878.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19878.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28099.27},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":28974.03},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30413.33},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19878.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19878.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":33057.97},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19878.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19878.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19878.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19878.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19878.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19878.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19878.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38002.19},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34712.06},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19878.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27571.02,"10th_percentile":27571.02,"90th_percentile":27571.02,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":9133.49,"10th_percentile":9133.49,"90th_percentile":9133.49,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6501.55,"10th_percentile":6501.55,"90th_percentile":6501.55,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":82500.05,"10th_percentile":82500.05,"90th_percentile":82500.05,"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":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":8288.97,"10th_percentile":8288.97,"90th_percentile":8288.97,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16902.26,"10th_percentile":16902.26,"90th_percentile":16902.26,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":80489.81,"10th_percentile":80489.81,"90th_percentile":80489.81,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":32572.97,"10th_percentile":32572.97,"90th_percentile":32572.97},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":8533.04,"10th_percentile":8533.04,"90th_percentile":8533.04,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":5159.48,"10th_percentile":5159.48,"90th_percentile":5159.48,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16894.24,"10th_percentile":16894.24,"90th_percentile":16894.24,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/Mcc","code_information":[{"code":"858","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13114.17,"maximum":22470.98,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17068.72},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13114.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13114.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16615.31},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":17132.56},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17983.63},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13114.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13114.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":19547.42},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13114.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13114.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13114.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13114.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13114.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13114.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13114.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22470.98},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20525.5},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13114.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":27995.22,"10th_percentile":27995.22,"90th_percentile":27995.22,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postoperative And Post-Traumatic Infections With Mcc","code_information":[{"code":"862","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17007.07,"maximum":32067.02,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24357.77},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17007.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17007.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23710.73},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":24448.88},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25663.38},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17007.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17007.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":27894.98},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17007.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17007.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17007.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17007.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17007.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17007.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17007.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32067.02},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29290.74},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17007.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12298.77,"10th_percentile":12298.77,"90th_percentile":12298.77,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":5371.65,"10th_percentile":5371.65,"90th_percentile":5371.65,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2041.61,"10th_percentile":2041.61,"90th_percentile":2041.61,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":28596.94,"10th_percentile":28596.94,"90th_percentile":108968.37,"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":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":7991.73,"10th_percentile":7991.73,"90th_percentile":7991.73,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13892.23,"10th_percentile":13892.23,"90th_percentile":13892.23,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"11","median_amount":28956.18,"10th_percentile":22598.5,"90th_percentile":59021.76,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":56746.02,"10th_percentile":56746.02,"90th_percentile":56746.02},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":7264.32,"10th_percentile":7264.32,"90th_percentile":7264.32,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14322.99,"10th_percentile":14322.99,"90th_percentile":14322.99,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":4905.26,"10th_percentile":4905.26,"90th_percentile":7989.73,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":32068.77,"10th_percentile":32068.77,"90th_percentile":32068.77,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14323.0,"10th_percentile":14323.0,"90th_percentile":14323.0,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postoperative And Post-Traumatic Infections Without Mcc","code_information":[{"code":"863","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9544.78,"maximum":17439.26,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13246.68},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9544.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9544.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12894.79},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":13296.22},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13956.71},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9544.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9544.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":15170.34},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9544.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9544.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9544.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9544.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9544.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9544.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9544.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17439.26},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15929.41},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9544.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11380.97,"10th_percentile":11380.97,"90th_percentile":11380.97,"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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":4162.12,"10th_percentile":4162.12,"90th_percentile":4162.12,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7963.55,"10th_percentile":7956.67,"90th_percentile":7980.63,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":33180.44,"10th_percentile":19787.01,"90th_percentile":42275.74,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":4905.26,"10th_percentile":4905.26,"90th_percentile":4905.26,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8221.64,"10th_percentile":8221.64,"90th_percentile":8221.64,"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":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":34331.2,"10th_percentile":16227.48,"90th_percentile":63728.85,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":22796.58,"10th_percentile":22796.58,"90th_percentile":22796.58},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":4695.77,"10th_percentile":4695.77,"90th_percentile":4695.77,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7956.67,"10th_percentile":7956.67,"90th_percentile":8221.02,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":7238.68,"10th_percentile":7238.68,"90th_percentile":7989.73,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":17297.05,"10th_percentile":17297.05,"90th_percentile":17297.05,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7963.55,"10th_percentile":7963.55,"90th_percentile":7963.55,"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":"Youthcare","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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":412.56,"10th_percentile":412.56,"90th_percentile":412.56,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27333.6,"10th_percentile":27333.6,"90th_percentile":27333.6,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":47337.51,"10th_percentile":33578.14,"90th_percentile":55840.16,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7198.15,"10th_percentile":7198.15,"90th_percentile":7204.49,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":5442.61,"10th_percentile":5442.61,"90th_percentile":5442.61,"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":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":14066.61,"maximum":25741.17,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19552.72},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14066.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14066.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19033.32},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":19625.85},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20600.77},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14066.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14066.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":22392.15},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14066.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14066.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14066.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14066.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14066.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14066.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14066.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25741.17},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23512.56},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14066.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":48884.96,"10th_percentile":48884.96,"90th_percentile":48884.96,"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":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":61837.87,"10th_percentile":61837.87,"90th_percentile":86665.68,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8369.39,"10th_percentile":7090.37,"90th_percentile":10579.16,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11572.38,"10th_percentile":11572.38,"90th_percentile":11572.38,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":8385.41,"maximum":15430.05,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11720.51},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8385.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8385.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11409.16},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11764.34},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12348.74},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8385.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8385.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":13422.54},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8385.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8385.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8385.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8385.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8385.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8385.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8385.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15430.05},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14094.16},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8385.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9377.46,"10th_percentile":9377.46,"90th_percentile":9377.46,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":4362.22,"10th_percentile":4362.22,"90th_percentile":4362.22,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27481.7,"10th_percentile":12574.97,"90th_percentile":45259.2,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":21792.0,"10th_percentile":19413.91,"90th_percentile":49888.66,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":2910.9,"10th_percentile":2910.9,"90th_percentile":2910.9},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":4834.38,"10th_percentile":4834.38,"90th_percentile":4834.38,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6980.22,"10th_percentile":6517.61,"90th_percentile":7127.93,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":3644.33,"10th_percentile":3644.33,"90th_percentile":3694.59,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":14731.92,"10th_percentile":14731.92,"90th_percentile":14731.92,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":2815.78,"10th_percentile":2815.78,"90th_percentile":2815.78,"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."}]}]},{"description":"Other Infectious And Parasitic Diseases Diagnoses With Mcc","code_information":[{"code":"867","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19442.39,"maximum":37396.99,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28406.36},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19442.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19442.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27651.77},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":28512.61},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29928.98},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19442.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19442.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":32531.5},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19442.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19442.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19442.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19442.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19442.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19442.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19442.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37396.99},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34159.25},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19442.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":5730.22,"10th_percentile":5730.22,"90th_percentile":5730.22,"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":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Infectious And Parasitic Diseases Diagnoses With Cc","code_information":[{"code":"868","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9844.79,"maximum":18313.05,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13910.4},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9844.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9844.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13540.88},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":13962.43},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14656.02},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9844.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9844.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":15930.45},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9844.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9844.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9844.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9844.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9844.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9844.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9844.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18313.05},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16727.55},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9844.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":15057.81,"10th_percentile":15057.81,"90th_percentile":15057.81,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":6737.98,"10th_percentile":6737.98,"90th_percentile":6737.98,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8230.42,"10th_percentile":8230.42,"90th_percentile":8230.42,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":18314.79,"10th_percentile":18314.79,"90th_percentile":18314.79,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Infectious And Parasitic Diseases Diagnoses Without Cc/Mcc","code_information":[{"code":"869","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7121.21,"maximum":12548.8,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9531.94},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7121.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7121.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9278.73},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":9567.59},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10042.86},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7121.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7121.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10916.15},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7121.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7121.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7121.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7121.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7121.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7121.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7121.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12548.8},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11462.35},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7121.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":47423.26,"10th_percentile":47423.26,"90th_percentile":47423.26,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septicemia Or Severe Sepsis With Mv >96 Hours","code_information":[{"code":"870","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":62985.33,"maximum":121328.32,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":92159.71},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62985.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62985.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":89711.58},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":92504.41},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":97099.59},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62985.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62985.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":105543.04},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62985.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62985.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62985.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62985.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62985.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62985.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62985.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":121328.32},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":110824.0},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62985.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":86733.2,"10th_percentile":86733.2,"90th_percentile":86733.2,"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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":49728.07,"10th_percentile":49728.07,"90th_percentile":49728.07,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":53883.26,"10th_percentile":53883.26,"90th_percentile":53883.26,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":237987.16,"10th_percentile":237987.16,"90th_percentile":237987.16,"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":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":279152.7,"10th_percentile":279152.7,"90th_percentile":279152.7,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":53228.8,"10th_percentile":53228.8,"90th_percentile":53228.8,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":54744.85,"10th_percentile":54744.85,"90th_percentile":54744.85,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":161905.09,"10th_percentile":130700.42,"90th_percentile":327062.74,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":53119.9,"10th_percentile":53119.9,"90th_percentile":53119.9,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":56577.92,"10th_percentile":56577.92,"90th_percentile":56577.92,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":52751.68,"10th_percentile":51891.09,"90th_percentile":53228.8,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":53675.8,"10th_percentile":53675.8,"90th_percentile":53675.8,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":67699.75,"10th_percentile":67699.75,"90th_percentile":67699.75,"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":"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":42143.64,"10th_percentile":42143.64,"90th_percentile":42143.64,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":53076.19,"10th_percentile":51297.11,"90th_percentile":84308.49,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":18080.6,"maximum":34224.47,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25996.55},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18080.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18080.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25305.98},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":26093.78},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27390.0},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18080.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18080.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":29771.74},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18080.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18080.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18080.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18080.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18080.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18080.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18080.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34224.47},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31261.4},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18080.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"11","median_amount":24133.83,"10th_percentile":13611.19,"90th_percentile":25993.9,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"31","median_amount":12634.21,"10th_percentile":5668.59,"90th_percentile":13545.54,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"91","median_amount":15245.05,"10th_percentile":6405.79,"90th_percentile":15513.76,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"12","median_amount":13645.58,"10th_percentile":13602.53,"90th_percentile":15245.01,"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":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"16","median_amount":36148.38,"10th_percentile":22881.09,"90th_percentile":85336.5,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"19","median_amount":57250.94,"10th_percentile":19350.83,"90th_percentile":165146.14,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient 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":7989.49,"10th_percentile":7289.11,"90th_percentile":13393.23,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"24","median_amount":14484.76,"10th_percentile":12906.55,"90th_percentile":15517.4,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14787.69,"10th_percentile":12139.38,"90th_percentile":15048.35,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"79","median_amount":49174.87,"10th_percentile":19514.84,"90th_percentile":116252.52,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":21913.23,"10th_percentile":8493.56,"90th_percentile":324461.96},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15133.65,"10th_percentile":12203.58,"90th_percentile":15824.04,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient 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":7989.49,"10th_percentile":5659.78,"90th_percentile":53686.79,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12443.38,"10th_percentile":12443.38,"90th_percentile":12443.38,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"117","median_amount":12535.35,"10th_percentile":6368.21,"90th_percentile":15313.85,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"15","median_amount":13777.18,"10th_percentile":7147.54,"90th_percentile":17403.4,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13645.65,"10th_percentile":13645.65,"90th_percentile":13871.28,"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":"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":"50","median_amount":12193.19,"10th_percentile":5897.65,"90th_percentile":22395.88,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"18","median_amount":12904.27,"10th_percentile":12904.26,"90th_percentile":15650.58,"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 Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":13460.3,"10th_percentile":5781.97,"90th_percentile":43327.14,"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":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"12","median_amount":33866.61,"10th_percentile":16065.7,"90th_percentile":34116.45,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"1 through 10","median_amount":30055.45,"10th_percentile":13063.42,"90th_percentile":31258.22,"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":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"95","median_amount":13298.56,"10th_percentile":7910.4,"90th_percentile":15307.76,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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":9774.31,"maximum":17981.67,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13658.69},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9774.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9774.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13295.86},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":13709.77},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14390.81},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9774.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9774.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":15642.19},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9774.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9774.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9774.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9774.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9774.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9774.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9774.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17981.67},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16424.86},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9774.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13556.68,"10th_percentile":7912.35,"90th_percentile":13742.24,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":5668.59,"10th_percentile":5182.81,"90th_percentile":8352.45,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"13","median_amount":8199.32,"10th_percentile":6423.98,"90th_percentile":8417.12,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6556.84,"10th_percentile":6556.84,"90th_percentile":6556.84,"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":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":26626.69,"10th_percentile":10311.1,"90th_percentile":80493.75,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"13","median_amount":29274.79,"10th_percentile":18750.06,"90th_percentile":43909.48,"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":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":6026.54,"10th_percentile":5182.81,"90th_percentile":7989.49,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8200.22,"10th_percentile":7042.31,"90th_percentile":8588.9,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"50","median_amount":31975.66,"10th_percentile":17510.65,"90th_percentile":66148.83,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":9574.24,"10th_percentile":9574.24,"90th_percentile":10439.6},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":5489.7,"10th_percentile":5182.81,"90th_percentile":6695.92,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7575.41,"10th_percentile":7575.41,"90th_percentile":7575.41,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"15","median_amount":6479.4,"10th_percentile":5715.05,"90th_percentile":8210.41,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6645.13,"10th_percentile":6645.13,"90th_percentile":8287.62,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6774.64,"10th_percentile":6774.64,"90th_percentile":6774.64,"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":"[Inpatient 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":5668.59,"10th_percentile":4570.45,"90th_percentile":7026.91,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6044.34,"10th_percentile":6044.34,"90th_percentile":7259.2,"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 Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":6494.07,"10th_percentile":6494.07,"90th_percentile":6494.07,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":11521.62,"10th_percentile":11521.62,"90th_percentile":11521.62,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"1 through 10","median_amount":862.4,"10th_percentile":862.4,"90th_percentile":862.4,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"24","median_amount":6592.12,"10th_percentile":4639.37,"90th_percentile":8199.32,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":34985.86,"10th_percentile":34985.86,"90th_percentile":34985.86,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":"1 through 10","median_amount":3093.73,"10th_percentile":3093.73,"90th_percentile":3093.73,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":2933.96,"10th_percentile":2933.96,"90th_percentile":2933.96,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4178.95,"10th_percentile":4178.95,"90th_percentile":4178.95,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":22482.1,"10th_percentile":18527.34,"90th_percentile":49233.95,"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":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11595.98,"10th_percentile":11595.98,"90th_percentile":11595.98,"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":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":3987.88,"10th_percentile":1872.1,"90th_percentile":5876.09,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7663.0,"10th_percentile":7663.0,"90th_percentile":7663.0,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10381.72,"10th_percentile":10381.72,"90th_percentile":10381.72,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"14","median_amount":24994.25,"10th_percentile":15123.32,"90th_percentile":51658.39,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":6902.0,"10th_percentile":6902.0,"90th_percentile":20080.87},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7825.61,"10th_percentile":7825.61,"90th_percentile":8156.72,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":0.04,"10th_percentile":0.04,"90th_percentile":0.04,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":2498.37,"10th_percentile":2123.4,"90th_percentile":4578.45,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":4658.48,"10th_percentile":4658.48,"90th_percentile":4658.48,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8117.62,"10th_percentile":8117.62,"90th_percentile":12931.29,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":9029.71,"maximum":15942.82,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12110.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9029.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9029.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11788.31},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":12155.29},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12759.11},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9029.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9029.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":13868.6},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9029.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9029.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9029.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9029.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9029.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9029.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9029.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15942.82},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14562.53},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9029.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12110.0,"10th_percentile":5241.02,"90th_percentile":15754.73,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":3945.02,"10th_percentile":3945.02,"90th_percentile":4560.62,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10346.1,"10th_percentile":10346.1,"90th_percentile":10346.1,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":29129.42,"10th_percentile":29129.42,"90th_percentile":29129.42,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15186.76,"10th_percentile":12329.74,"90th_percentile":17905.22,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":2334.6,"10th_percentile":822.46,"90th_percentile":6439.82,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"30","median_amount":17397.88,"10th_percentile":10889.07,"90th_percentile":25706.83,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":3944.0,"10th_percentile":3944.0,"90th_percentile":3944.0},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":2697.62,"10th_percentile":2061.92,"90th_percentile":4989.6,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6777.01,"10th_percentile":6777.01,"90th_percentile":6777.01,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":0.07,"10th_percentile":0.07,"90th_percentile":0.07,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":2494.8,"10th_percentile":1353.05,"90th_percentile":3321.32,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":2544.68,"10th_percentile":2544.68,"90th_percentile":3817.02,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":6054.0,"10th_percentile":2421.6,"90th_percentile":16410.24,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"1 through 10","median_amount":3095.34,"10th_percentile":3095.34,"90th_percentile":3095.34,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1721.16,"10th_percentile":1721.16,"90th_percentile":1721.16,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":10230.65,"maximum":16776.5,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12743.25},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10230.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10230.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12404.74},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":12790.91},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13426.31},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10230.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10230.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":14593.81},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10230.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10230.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10230.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10230.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10230.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10230.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10230.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16776.5},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15324.03},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10230.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14225.7,"10th_percentile":14225.7,"90th_percentile":14225.7,"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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":19697.13,"10th_percentile":19697.13,"90th_percentile":19697.13,"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":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13372.67,"10th_percentile":13372.67,"90th_percentile":13372.67,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":5188.45,"10th_percentile":5188.45,"90th_percentile":5188.45,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":13304.03,"10th_percentile":10630.92,"90th_percentile":284873.01,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":6902.0,"10th_percentile":6902.0,"90th_percentile":6902.0},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":5360.4,"10th_percentile":5360.4,"90th_percentile":5360.4,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7676.19,"10th_percentile":7676.19,"90th_percentile":7676.19,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":2693.65,"10th_percentile":2693.65,"90th_percentile":2693.65,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":3220.29,"10th_percentile":3220.29,"90th_percentile":3220.29,"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":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":5045.0,"10th_percentile":5045.0,"90th_percentile":7063.0,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"1 through 10","median_amount":2753.0,"10th_percentile":2753.0,"90th_percentile":2753.0,"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":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6902.0,"10th_percentile":6902.0,"90th_percentile":6902.0,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Personality And Impulse Control","code_information":[{"code":"883","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18295.66,"maximum":32377.47,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24593.59},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18295.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18295.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23940.28},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":24685.57},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25911.84},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18295.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18295.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":28165.04},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18295.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18295.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18295.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18295.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18295.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18295.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18295.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32377.47},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29574.31},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18295.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":9292.83,"10th_percentile":9292.83,"90th_percentile":9292.83,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":4639.78,"10th_percentile":4639.78,"90th_percentile":4639.78,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":18288.7,"10th_percentile":18288.7,"90th_percentile":19670.73,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":3944.0,"10th_percentile":3944.0,"90th_percentile":3944.0},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":4631.96,"10th_percentile":4631.96,"90th_percentile":5887.18,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":4005.15,"10th_percentile":4005.15,"90th_percentile":4005.15,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":15648.0,"10th_percentile":15648.0,"90th_percentile":15648.0,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"1 through 10","median_amount":8366.7,"10th_percentile":8366.7,"90th_percentile":8366.7,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Organic Disturbances And Intellectual Disability","code_information":[{"code":"884","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15066.04,"maximum":29128.21,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22125.48},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15066.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15066.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21537.74},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":22208.24},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23311.44},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15066.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15066.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":25338.52},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15066.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15066.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15066.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15066.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15066.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15066.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15066.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29128.21},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26606.36},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15066.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21965.53,"10th_percentile":21965.53,"90th_percentile":21965.53,"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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12968.19,"10th_percentile":12968.19,"90th_percentile":13033.98,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":2899.48,"10th_percentile":2899.48,"90th_percentile":2899.48,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12654.11,"10th_percentile":12654.11,"90th_percentile":12654.11,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":42182.16,"10th_percentile":42182.16,"90th_percentile":42182.16,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":28594.0,"10th_percentile":28594.0,"90th_percentile":28594.0},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":7013.0,"10th_percentile":7013.0,"90th_percentile":7013.0,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12496.83,"10th_percentile":5760.44,"90th_percentile":13045.48,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":7856.73,"10th_percentile":7856.73,"90th_percentile":7856.73,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":6054.0,"10th_percentile":6054.0,"90th_percentile":6054.0,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12551.12,"10th_percentile":8467.01,"90th_percentile":13065.59,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Psychoses","code_information":[{"code":"885","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13149.42,"maximum":24583.09,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18673.06},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13149.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13149.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18177.02},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":18742.9},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19673.96},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13149.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13149.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":21384.74},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13149.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13149.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13149.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13149.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13149.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13149.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13149.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24583.09},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22454.74},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13149.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"97","median_amount":16220.5,"10th_percentile":7143.66,"90th_percentile":18674.38,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient 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":3953.4,"10th_percentile":2144.08,"90th_percentile":7757.38,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"11","median_amount":8405.74,"10th_percentile":2780.11,"90th_percentile":21834.61,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1841.7,"10th_percentile":1841.7,"90th_percentile":1841.7,"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":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"57","median_amount":22534.95,"10th_percentile":13908.16,"90th_percentile":45243.39,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"87","median_amount":22269.4,"10th_percentile":11985.9,"90th_percentile":33482.98,"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":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"105","median_amount":3742.2,"10th_percentile":1871.1,"90th_percentile":7065.87,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11618.79,"10th_percentile":8754.54,"90th_percentile":26559.54,"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":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5672.86,"10th_percentile":4028.68,"90th_percentile":10737.62,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"363","median_amount":21730.19,"10th_percentile":12817.05,"90th_percentile":35577.32,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"46","median_amount":4930.0,"10th_percentile":2366.4,"90th_percentile":12094.31},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5336.41,"10th_percentile":5336.41,"90th_percentile":6429.22,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient 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":4004.28,"10th_percentile":2353.98,"90th_percentile":8934.57,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"21","median_amount":6612.7,"10th_percentile":3333.97,"90th_percentile":11068.87,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":0.09,"10th_percentile":0.03,"90th_percentile":21829.18,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"105","median_amount":3229.94,"10th_percentile":1871.1,"90th_percentile":5984.52,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5161.32,"10th_percentile":4152.64,"90th_percentile":8808.1,"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":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient 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":3817.02,"10th_percentile":2170.2,"90th_percentile":7276.31,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"89","median_amount":6054.0,"10th_percentile":2240.33,"90th_percentile":10090.0,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"1 through 10","median_amount":4036.0,"10th_percentile":2905.99,"90th_percentile":11287.4,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"20","median_amount":6297.78,"10th_percentile":2592.19,"90th_percentile":14576.68,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":3321.32,"10th_percentile":3321.32,"90th_percentile":3321.32,"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."}]}]},{"description":"Behavioral And Developmental Disorders","code_information":[{"code":"886","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19280.63,"maximum":31331.01,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23798.71},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19280.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19280.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23166.52},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":23887.72},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25074.35},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19280.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19280.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":27254.73},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19280.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19280.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19280.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19280.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19280.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19280.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19280.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31331.01},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28618.45},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19280.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23800.03,"10th_percentile":23800.03,"90th_percentile":23800.03,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":29069.0,"10th_percentile":29069.0,"90th_percentile":29069.0,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":17074.81,"10th_percentile":17074.81,"90th_percentile":26503.69,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":2751.36,"10th_percentile":2751.36,"90th_percentile":2751.36,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":5096.98,"10th_percentile":5096.98,"90th_percentile":5096.98,"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":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":6343.36,"10th_percentile":6343.36,"90th_percentile":6343.36,"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":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":9081.0,"10th_percentile":9081.0,"90th_percentile":21141.0,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":3929.82,"10th_percentile":3929.82,"90th_percentile":3929.82,"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."}]}]},{"description":"Other Mental Disorder Diagnoses","code_information":[{"code":"887","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10204.44,"maximum":20742.58,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15755.85},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10204.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10204.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15337.31},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":15814.78},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16600.38},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10204.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10204.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":18043.89},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10204.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10204.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10204.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10204.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10204.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10204.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10204.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20742.58},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18946.74},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10204.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":114799.12,"10th_percentile":114799.12,"90th_percentile":114799.12,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","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":"1 through 10","median_amount":353.69,"10th_percentile":353.69,"90th_percentile":353.69,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":30320.24,"10th_percentile":30320.24,"90th_percentile":30320.24,"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":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":25282.65,"10th_percentile":25282.65,"90th_percentile":34542.47,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":2691.42,"10th_percentile":2691.42,"90th_percentile":2691.42,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":2852.13,"10th_percentile":353.69,"90th_percentile":4458.97,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Alcohol, Drug Abuse Or Dependence With Rehabilitation Therapy","code_information":[{"code":"895","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13319.3,"maximum":25252.82,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19181.78},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13319.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13319.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18672.23},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":19253.52},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20209.95},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13319.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13319.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":21967.34},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13319.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13319.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13319.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13319.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13319.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13319.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13319.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25252.82},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23066.49},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13319.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":5698.15,"10th_percentile":5698.15,"90th_percentile":13423.94,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":45515.29,"10th_percentile":45515.29,"90th_percentile":45515.29,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30686.95,"10th_percentile":30686.95,"90th_percentile":30899.85,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":5694.13,"10th_percentile":5694.13,"90th_percentile":6257.81,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12855.0,"10th_percentile":12855.0,"90th_percentile":12855.0,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":38542.22,"10th_percentile":27146.82,"90th_percentile":368186.8,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":5694.13,"10th_percentile":3486.12,"90th_percentile":6778.93,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":4458.97,"10th_percentile":4458.97,"90th_percentile":4458.97,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11560.13,"10th_percentile":11560.13,"90th_percentile":11560.13,"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 Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":1257.15,"10th_percentile":1257.15,"90th_percentile":1257.15,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":19355.61,"10th_percentile":19355.61,"90th_percentile":19355.61,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12519.75,"10th_percentile":12519.75,"90th_percentile":12519.75,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc","code_information":[{"code":"897","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8504.69,"maximum":15386.45,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11687.39},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8504.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8504.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11376.92},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11731.1},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12313.84},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8504.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8504.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":13384.61},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8504.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8504.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8504.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8504.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8504.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8504.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8504.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15386.45},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14054.33},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8504.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11687.39,"10th_percentile":10952.51,"90th_percentile":11695.33,"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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient 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":2793.84,"10th_percentile":353.69,"90th_percentile":5694.13,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7332.95,"10th_percentile":7332.95,"90th_percentile":7332.95,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"11","median_amount":19303.28,"10th_percentile":15893.55,"90th_percentile":28602.09,"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":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":33618.83,"10th_percentile":18302.89,"90th_percentile":69957.31,"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":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient 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":3820.83,"10th_percentile":2198.57,"90th_percentile":6253.81,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6477.1,"10th_percentile":6477.1,"90th_percentile":6477.1,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2664.51,"10th_percentile":2664.51,"90th_percentile":2664.51,"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":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"38","median_amount":23466.72,"10th_percentile":9994.65,"90th_percentile":46476.77,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":3634.01,"10th_percentile":3634.01,"90th_percentile":8213.63},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient 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":3486.12,"10th_percentile":2494.8,"90th_percentile":4095.89,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7084.46,"10th_percentile":4436.6,"90th_percentile":7332.95,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"53","median_amount":3486.12,"10th_percentile":2623.25,"90th_percentile":4699.64,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":2888.52,"10th_percentile":360.76,"90th_percentile":5457.45,"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":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":3890.36,"10th_percentile":3820.83,"90th_percentile":4843.2,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"1 through 10","median_amount":10090.0,"10th_percentile":10090.0,"90th_percentile":10090.0,"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":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6466.12,"10th_percentile":5248.39,"90th_percentile":7065.11,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridements For Injuries With Mcc","code_information":[{"code":"901","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":38449.61,"maximum":77267.12,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58691.29},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38449.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38449.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":57132.21},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":58910.81},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":61837.22},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38449.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38449.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":67214.37},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38449.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38449.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38449.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38449.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38449.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38449.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38449.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":77267.12},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":70577.52},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38449.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridements For Injuries With Cc","code_information":[{"code":"902","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17827.58,"maximum":33092.55,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25136.76},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17827.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17827.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24469.02},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":25230.77},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26484.12},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17827.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17827.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":28787.09},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17827.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17827.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17827.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17827.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17827.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17827.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17827.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33092.55},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30227.48},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17827.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15297.6,"10th_percentile":15297.6,"90th_percentile":15297.6,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":34447.7,"10th_percentile":34447.7,"90th_percentile":34447.7,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":13265.18,"10th_percentile":13265.18,"90th_percentile":13265.18},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":4126.08,"10th_percentile":4126.08,"90th_percentile":4126.08,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13626.4,"10th_percentile":13626.4,"90th_percentile":13626.4,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridements For Injuries Without Cc/Mcc","code_information":[{"code":"903","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11096.34,"maximum":21260.58,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16149.31},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11096.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11096.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15720.32},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":16209.71},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17014.94},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11096.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11096.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":18494.5},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11096.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11096.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11096.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11096.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11096.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11096.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11096.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21260.58},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19419.89},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11096.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":34721.51,"10th_percentile":34721.51,"90th_percentile":34721.51,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9164.83,"10th_percentile":9164.83,"90th_percentile":9164.83,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts For Injuries With Cc/Mcc","code_information":[{"code":"904","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33719.04,"maximum":67337.96,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51149.2},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33719.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33719.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":49790.48},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":51340.51},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":53890.87},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33719.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33719.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":58577.03},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33719.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33719.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33719.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33719.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33719.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33719.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33719.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67337.96},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":61508.0},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33719.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts For Injuries Without Cc/Mcc","code_information":[{"code":"905","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13931.97,"maximum":28744.51,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21834.03},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13931.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13931.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21254.03},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":21915.69},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23004.36},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13931.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13931.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":25004.74},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13931.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13931.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13931.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13931.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13931.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13931.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13931.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28744.51},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26255.88},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13931.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":36535.64,"10th_percentile":36535.64,"90th_percentile":36535.64,"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":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hand Procedures For Injuries","code_information":[{"code":"906","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18277.59,"maximum":38063.24,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28912.44},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18277.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18277.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28144.4},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":29020.57},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30462.18},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18277.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18277.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":33111.07},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18277.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18277.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18277.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18277.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18277.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18277.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18277.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38063.24},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34767.81},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18277.59,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":183266.43,"10th_percentile":183266.43,"90th_percentile":183266.43,"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":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":86850.62,"10th_percentile":86850.62,"90th_percentile":86850.62,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":32534.91,"10th_percentile":32534.91,"90th_percentile":32534.91,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":56080.05,"10th_percentile":56080.05,"90th_percentile":56080.05,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":29541.82,"10th_percentile":29541.82,"90th_percentile":29541.82,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27892.14,"10th_percentile":27892.14,"90th_percentile":27892.14,"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":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30583.13,"10th_percentile":30583.13,"90th_percentile":30583.13,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other 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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9997.69,"10th_percentile":9997.69,"90th_percentile":15682.17,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":45823.63,"10th_percentile":45823.63,"90th_percentile":45823.63,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":62482.72,"10th_percentile":62482.72,"90th_percentile":107275.13,"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":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":8262.68,"10th_percentile":8262.68,"90th_percentile":8262.68,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":54431.05,"10th_percentile":37001.25,"90th_percentile":71520.16,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13950.84,"10th_percentile":13950.84,"90th_percentile":13950.84,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15668.13,"10th_percentile":15668.13,"90th_percentile":15668.13,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":9825.13,"10th_percentile":9825.13,"90th_percentile":9825.13,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15920.64,"10th_percentile":15920.64,"90th_percentile":15920.64,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":12389.45,"maximum":22118.68,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16801.11},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12389.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12389.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16354.81},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":16863.95},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17701.68},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12389.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12389.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":19240.95},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12389.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12389.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12389.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12389.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12389.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12389.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12389.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22118.68},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20203.69},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12389.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16309.74,"10th_percentile":16309.74,"90th_percentile":16309.74,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10001.33,"10th_percentile":10001.33,"90th_percentile":10001.33,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30830.93,"10th_percentile":30830.93,"90th_percentile":81115.61,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":30236.25,"10th_percentile":29830.39,"90th_percentile":45325.19,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9997.69,"10th_percentile":9997.69,"90th_percentile":9997.69,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8715.93,"10th_percentile":8715.93,"90th_percentile":8715.93,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":15298.28,"maximum":28223.03,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21437.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15298.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15298.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20868.44},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":21518.1},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22587.01},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15298.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15298.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":24551.1},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15298.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15298.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15298.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15298.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15298.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15298.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15298.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28223.03},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25779.54},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15298.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Multiple Significant Trauma Without Cc/Mcc","code_information":[{"code":"959","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27131.48,"maximum":46108.77,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35023.74},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27131.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27131.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34093.37},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":35154.73},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36901.06},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27131.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27131.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":40109.85},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27131.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27131.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27131.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27131.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27131.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27131.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27131.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46108.77},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":42116.78},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27131.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":88494.35,"10th_percentile":88494.35,"90th_percentile":88494.35,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":25231.12,"maximum":47380.22,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35989.52},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25231.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25231.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35033.49},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":36124.12},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37918.6},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25231.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25231.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":41215.87},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25231.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25231.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25231.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25231.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25231.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25231.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25231.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47380.22},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43278.15},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25231.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5000.0,"10th_percentile":5000.0,"90th_percentile":5000.0,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":76854.26,"10th_percentile":76854.26,"90th_percentile":76854.26,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Multiple Significant Trauma With Cc","code_information":[{"code":"964","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14376.56,"maximum":26164.99,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19874.65},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14376.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14376.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19346.7},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":19948.98},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20939.96},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14376.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14376.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":22760.82},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14376.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14376.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14376.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14376.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14376.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14376.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14376.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26164.99},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23899.69},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14376.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17208.29,"10th_percentile":17208.29,"90th_percentile":17208.29,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11766.84,"10th_percentile":11766.84,"90th_percentile":11766.84,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11608.2,"10th_percentile":11608.2,"90th_percentile":11608.2,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":63446.42,"10th_percentile":63446.42,"90th_percentile":63446.42,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11745.54,"10th_percentile":11745.54,"90th_percentile":11745.54,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11754.98,"10th_percentile":11754.98,"90th_percentile":11754.98,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Multiple Significant Trauma Without Cc/Mcc","code_information":[{"code":"965","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9026.09,"maximum":15914.91,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12088.8},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9026.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9026.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11767.67},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":12134.01},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12736.78},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9026.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9026.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":13844.32},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9026.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9026.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9026.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9026.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9026.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9026.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9026.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15914.91},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14537.04},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9026.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1300.63,"10th_percentile":1300.63,"90th_percentile":1300.63,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Extensive O.R. Procedures With Mcc","code_information":[{"code":"969","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":55842.03,"maximum":110295.14,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":83779.03},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55842.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55842.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":81553.52},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":84092.38},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":88269.69},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55842.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55842.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":95945.33},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55842.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55842.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55842.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55842.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55842.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55842.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55842.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":110295.14},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":100746.05},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55842.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":24360.01,"maximum":46274.46,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35149.59},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24360.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24360.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34215.88},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":35281.06},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37033.66},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24360.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24360.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":40253.98},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24360.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24360.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24360.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24360.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24360.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24360.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24360.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46274.46},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":42268.13},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24360.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":26606.47,"maximum":52078.83,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39558.53},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26606.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26606.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38507.69},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":39706.48},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41678.92},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26606.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26606.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":45303.17},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26606.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26606.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26606.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26606.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26606.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26606.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26606.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52078.83},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":47569.97},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26606.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":140247.34,"10th_percentile":140247.34,"90th_percentile":140247.34,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":15274.97,"10th_percentile":15274.97,"90th_percentile":15274.97,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":287193.5,"10th_percentile":287193.5,"90th_percentile":287193.5,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":34616.48,"10th_percentile":34616.48,"90th_percentile":34616.48},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":12229.51,"maximum":24788.89,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18829.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12229.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12229.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18329.2},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":18899.81},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19838.66},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12229.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12229.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":21563.76},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12229.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12229.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12229.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12229.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12229.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12229.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12229.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24788.89},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22642.73},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12229.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":4623.75,"10th_percentile":4623.75,"90th_percentile":4623.75,"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":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":8684.52,"maximum":17491.58,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13286.42},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8684.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8684.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12933.48},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":13336.11},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13998.59},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8684.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8684.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":15215.86},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8684.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8684.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8684.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8684.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8684.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8684.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8684.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17491.58},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15977.2},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8684.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":12253.91,"maximum":25146.43,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19100.97},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12253.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12253.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18593.57},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":19172.41},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20124.8},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12253.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12253.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":21874.79},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12253.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12253.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12253.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12253.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12253.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12253.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12253.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25146.43},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22969.32},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12253.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":51768.94,"10th_percentile":51768.94,"90th_percentile":51768.94,"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":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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]","count":"1 through 10","median_amount":20184.03,"10th_percentile":20184.03,"90th_percentile":20184.03,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":36392.14,"10th_percentile":25239.02,"90th_percentile":36424.88,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":253595.88,"10th_percentile":253595.88,"90th_percentile":253595.88,"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":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":69095.95,"10th_percentile":69095.95,"90th_percentile":69095.95,"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":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":28195.61,"10th_percentile":28195.61,"90th_percentile":196069.75,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":35332.13,"10th_percentile":35332.13,"90th_percentile":35332.13,"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":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":68641.93,"10th_percentile":65345.66,"90th_percentile":210296.83,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":36392.14,"10th_percentile":35318.46,"90th_percentile":36739.61,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":55712.55,"10th_percentile":55712.55,"90th_percentile":55712.55,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":26308.46,"10th_percentile":26308.46,"90th_percentile":26308.46,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":35766.19,"10th_percentile":33645.43,"90th_percentile":71526.88,"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 Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":82912.77,"10th_percentile":82912.77,"90th_percentile":82912.77,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":36739.61,"10th_percentile":36392.15,"90th_percentile":48537.2,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive 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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":29486.19,"10th_percentile":29486.19,"90th_percentile":133822.08,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18944.73,"10th_percentile":18944.73,"90th_percentile":18944.73,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":97912.98,"10th_percentile":97912.98,"90th_percentile":97912.98,"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":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":135206.08,"10th_percentile":135206.08,"90th_percentile":135206.08,"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":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":6971.52,"10th_percentile":6971.52,"90th_percentile":6971.52,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17212.88,"10th_percentile":17212.88,"90th_percentile":17212.88,"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":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18376.39,"10th_percentile":18376.39,"90th_percentile":18376.39,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":73152.26,"10th_percentile":73152.26,"90th_percentile":73152.26,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":29927.16,"10th_percentile":29927.16,"90th_percentile":29927.16},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":13364.95,"10th_percentile":13364.95,"90th_percentile":13364.95,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18222.38,"10th_percentile":17989.23,"90th_percentile":19497.52,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":13419.51,"10th_percentile":9281.92,"90th_percentile":14278.21,"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":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17562.03,"10th_percentile":17562.03,"90th_percentile":17562.03,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive 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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6311.12,"10th_percentile":6311.12,"90th_percentile":6311.12,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":158552.09,"10th_percentile":158552.09,"90th_percentile":158552.09,"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":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":61734.3,"10th_percentile":61734.3,"90th_percentile":61734.3,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":57737.47,"10th_percentile":57737.47,"90th_percentile":57737.47,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":7569.91,"10th_percentile":7569.91,"90th_percentile":7569.91,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13053.72,"10th_percentile":13053.72,"90th_percentile":13053.72,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":7362.75,"10th_percentile":7362.75,"90th_percentile":7362.75,"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":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":24275.37,"10th_percentile":24275.37,"90th_percentile":24275.37,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"1 through 10","median_amount":25553.49,"10th_percentile":25553.49,"90th_percentile":25553.49,"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":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23985.25,"10th_percentile":23985.25,"90th_percentile":23985.25,"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":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":117024.14,"10th_percentile":117024.14,"90th_percentile":117024.14,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":106397.61,"10th_percentile":106397.61,"90th_percentile":106397.61,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12498.92,"10th_percentile":12498.92,"90th_percentile":12498.92,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26938.76,"10th_percentile":26938.76,"90th_percentile":26938.76,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Extensive 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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":14330.27,"10th_percentile":14330.27,"90th_percentile":14330.27,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":38253.73,"10th_percentile":38253.73,"90th_percentile":38253.73,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1443.45,"10th_percentile":1443.45,"90th_percentile":1443.45,"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":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12810.92,"10th_percentile":12810.92,"90th_percentile":12810.92,"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":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":86343.88,"10th_percentile":86343.88,"90th_percentile":86343.88,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":4428.32,"10th_percentile":4428.32,"90th_percentile":4428.32,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11523.48,"10th_percentile":11523.48,"90th_percentile":11523.48,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc","code_information":[{"code":"989","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11363.82,"maximum":20151.33,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15306.74},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11363.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11363.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14900.13},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":15363.99},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16127.2},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11363.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11363.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":17529.57},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11363.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11363.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11363.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11363.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11363.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11363.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11363.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20151.33},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18406.68},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11363.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":36665.98,"10th_percentile":36665.98,"90th_percentile":36665.98,"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":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":41060.33,"10th_percentile":41060.33,"90th_percentile":41060.33,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":7147.94,"10th_percentile":7147.94,"90th_percentile":7147.94,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9271.93,"10th_percentile":9271.93,"90th_percentile":9271.93,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":15362.03,"10th_percentile":15362.03,"90th_percentile":15362.03,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":8529.09,"maximum":15981.19,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12139.14},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8529.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8529.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11816.68},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":12184.55},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12789.82},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8529.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8529.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":13901.98},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8529.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8529.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8529.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8529.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8529.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8529.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8529.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15981.19},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14597.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8529.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7332.13,"10th_percentile":7332.13,"90th_percentile":7332.13,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":26109.72,"10th_percentile":26109.72,"90th_percentile":26109.72,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":843.59,"10th_percentile":843.59,"90th_percentile":843.59,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7363.25,"10th_percentile":7363.25,"90th_percentile":7363.25,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":15722.99,"maximum":30308.97,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23022.37},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15722.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15722.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22410.81},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":23108.48},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24256.4},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15722.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15722.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":26365.66},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15722.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15722.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15722.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15722.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15722.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15722.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15722.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30308.97},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27684.89},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15722.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":77143.85,"10th_percentile":77143.85,"90th_percentile":77143.85,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":40157.2,"10th_percentile":40157.2,"90th_percentile":40157.2,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5420.86,"10th_percentile":5420.86,"90th_percentile":5420.86,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":28700.0,"10th_percentile":28700.0,"90th_percentile":28700.0,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":6548.3,"maximum":11580.82,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8796.67},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6548.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6548.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8563.0},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":8829.57},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9268.19},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6548.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6548.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10074.12},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6548.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6548.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6548.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6548.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6548.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6548.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6548.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11580.82},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10578.18},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6548.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":2259.45,"10th_percentile":2259.45,"90th_percentile":2259.45,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10962.79,"10th_percentile":10962.79,"90th_percentile":10962.79,"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":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":14002.67,"10th_percentile":14002.67,"90th_percentile":14002.67,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":6434.74,"10th_percentile":6434.74,"90th_percentile":6434.74},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":17764.83,"10th_percentile":17764.83,"90th_percentile":17764.83,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":476.28,"10th_percentile":476.28,"90th_percentile":476.28,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"1 through 10","median_amount":10579.78,"10th_percentile":10579.78,"90th_percentile":10579.78,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Poisoning And Toxic Effects Of Drugs With Mcc","code_information":[{"code":"917","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14700.07,"maximum":28596.26,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21721.42},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14700.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14700.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21144.41},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":21802.66},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22885.72},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14700.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14700.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":24875.78},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14700.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14700.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14700.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14700.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14700.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14700.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14700.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28596.26},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26120.47},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14700.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20902.72,"10th_percentile":20902.72,"90th_percentile":20902.72,"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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":5766.54,"10th_percentile":5766.54,"90th_percentile":5766.54,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6317.88,"10th_percentile":6317.88,"90th_percentile":6317.88,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":36962.56,"10th_percentile":36962.56,"90th_percentile":36962.56,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":33699.8,"10th_percentile":33699.8,"90th_percentile":33699.8,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":5850.52,"10th_percentile":5850.52,"90th_percentile":9067.8,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":56426.75,"10th_percentile":39044.94,"90th_percentile":86862.57,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":5338.98,"10th_percentile":5338.98,"90th_percentile":5338.98,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12652.84,"10th_percentile":12049.85,"90th_percentile":12808.22,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12973.59,"10th_percentile":12973.59,"90th_percentile":12973.59,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":5055.4,"10th_percentile":5055.4,"90th_percentile":9170.23,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10514.04,"10th_percentile":10514.04,"90th_percentile":10514.04,"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 Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":3892.39,"10th_percentile":3892.39,"90th_percentile":3892.39,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":28598.01,"10th_percentile":28598.01,"90th_percentile":28598.01,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10965.46,"10th_percentile":1735.58,"90th_percentile":12625.54,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Poisoning And Toxic Effects Of Drugs Without Mcc","code_information":[{"code":"918","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8272.45,"maximum":15424.82,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11716.53},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8272.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8272.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11405.29},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11760.35},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12344.55},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8272.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8272.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":13417.99},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8272.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8272.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8272.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8272.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8272.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8272.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8272.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15424.82},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14089.38},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8272.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10529.13,"10th_percentile":10529.13,"90th_percentile":10529.13,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":23661.84,"10th_percentile":17666.19,"90th_percentile":26746.31,"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":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20310.49,"10th_percentile":19821.41,"90th_percentile":86899.7,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":3816.07,"10th_percentile":3816.07,"90th_percentile":4466.06,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"17","median_amount":25456.75,"10th_percentile":19319.28,"90th_percentile":54104.81,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":92.26,"10th_percentile":92.26,"90th_percentile":92.26,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":5850.52,"10th_percentile":3730.53,"90th_percentile":6151.05,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7227.85,"10th_percentile":7227.85,"90th_percentile":9042.77,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"12","median_amount":2431.21,"10th_percentile":537.75,"90th_percentile":3416.22,"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":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4958.95,"10th_percentile":4958.95,"90th_percentile":4958.95,"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":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":5045.0,"10th_percentile":1009.0,"90th_percentile":49940.5,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7088.85,"10th_percentile":7088.85,"90th_percentile":7088.85,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":17071.23,"maximum":31801.92,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24156.4},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17071.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17071.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23514.71},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":24246.75},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25451.22},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17071.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17071.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":27664.37},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17071.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17071.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17071.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17071.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17071.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17071.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17071.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31801.92},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29048.59},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17071.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":13507.17,"10th_percentile":13507.17,"90th_percentile":13507.17,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":41762.64,"10th_percentile":41762.64,"90th_percentile":41762.64,"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":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":6897.31,"10th_percentile":6897.31,"90th_percentile":6897.31,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14195.95,"10th_percentile":14195.95,"90th_percentile":14195.95,"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":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":43702.78,"10th_percentile":29515.58,"90th_percentile":66690.94,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":10935.98,"10th_percentile":10935.98,"90th_percentile":10935.98,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14208.5,"10th_percentile":14208.5,"90th_percentile":14216.3,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"1 through 10","median_amount":29051.77,"10th_percentile":29051.77,"90th_percentile":29051.77,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13873.86,"10th_percentile":13873.86,"90th_percentile":13873.86,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":9584.54,"maximum":17716.57,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13457.32},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9584.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9584.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13099.84},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":13507.65},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14178.65},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9584.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9584.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":15411.58},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9584.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9584.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9584.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9584.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9584.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9584.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9584.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17716.57},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16182.71},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9584.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":9139.98,"10th_percentile":9139.98,"90th_percentile":9139.98,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8077.8,"10th_percentile":6313.84,"90th_percentile":8089.0,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6438.62,"10th_percentile":6438.62,"90th_percentile":6438.62,"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":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":36120.35,"10th_percentile":36120.35,"90th_percentile":53959.02,"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":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":6668.31,"10th_percentile":6668.31,"90th_percentile":6668.31,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8077.84,"10th_percentile":8077.84,"90th_percentile":8077.84,"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":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":21105.71,"10th_percentile":10732.32,"90th_percentile":39791.48,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":39723.5,"10th_percentile":39723.5,"90th_percentile":39723.5},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8080.24,"10th_percentile":8080.24,"90th_percentile":8080.24,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":1183.08,"10th_percentile":1183.08,"90th_percentile":1183.08,"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":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":10213.19,"10th_percentile":10213.19,"90th_percentile":10213.19,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":17718.31,"10th_percentile":17718.31,"90th_percentile":17718.31,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8077.84,"10th_percentile":8077.84,"90th_percentile":8084.85,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complications Of Treatment Without Cc/Mcc","code_information":[{"code":"921","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6748.01,"maximum":11992.43,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9109.32},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6748.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6748.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8867.34},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":9143.4},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9597.6},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6748.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6748.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10432.17},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6748.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6748.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6748.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6748.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6748.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6748.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6748.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11992.43},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10954.16},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6748.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":24079.45,"10th_percentile":24079.45,"90th_percentile":24079.45,"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":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17182.95,"10th_percentile":17182.95,"90th_percentile":22651.19,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":4418.2,"10th_percentile":4418.2,"90th_percentile":4418.2,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":20466.42,"10th_percentile":10037.2,"90th_percentile":27351.51,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":11994.18,"10th_percentile":11994.18,"90th_percentile":11994.18,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":503.83,"10th_percentile":503.83,"90th_percentile":503.83,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Injury, Poisoning And Toxic Effect Diagnoses With Mcc","code_information":[{"code":"922","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16335.66,"maximum":29461.34,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22378.52},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16335.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16335.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21784.06},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":22462.22},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23578.04},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16335.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16335.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":25628.31},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16335.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16335.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16335.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16335.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16335.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16335.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16335.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29461.34},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26910.65},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16335.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":6034.68,"10th_percentile":6034.68,"90th_percentile":6034.68,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":103538.07,"10th_percentile":103538.07,"90th_percentile":103538.07,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":11149.57,"10th_percentile":11149.57,"90th_percentile":11149.57},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":798.91,"10th_percentile":798.91,"90th_percentile":798.91,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Injury, Poisoning And Toxic Effect Diagnoses Without Mcc","code_information":[{"code":"923","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9723.7,"maximum":17786.33,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13510.31},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9723.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9723.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13151.42},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":13560.84},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14234.48},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9723.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9723.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":15472.26},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9723.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9723.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9723.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9723.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9723.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9723.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9723.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17786.33},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16246.43},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9723.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":99423.72,"10th_percentile":99423.72,"90th_percentile":99423.72,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":19634.06,"10th_percentile":19634.06,"90th_percentile":19634.06,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8115.18,"10th_percentile":8115.18,"90th_percentile":8115.18,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft","code_information":[{"code":"927","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":193459.63,"maximum":413749.35,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":314279.65},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":193459.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":193459.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":305931.13},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":315455.12},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":331125.45},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":193459.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":193459.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":359919.0},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":193459.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":193459.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":193459.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":193459.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":193459.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":193459.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":193459.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":413749.35},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":377927.93},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":193459.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/Mcc","code_information":[{"code":"928","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":65342.93,"maximum":116479.72,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":88476.77},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65342.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65342.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":86126.47},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":88807.69},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":93219.24},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65342.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65342.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":101325.27},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65342.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65342.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65342.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65342.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65342.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65342.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65342.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":116479.72},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":106395.18},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65342.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/Mcc","code_information":[{"code":"929","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29631.86,"maximum":55465.87,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42131.29},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29631.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29631.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41012.11},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":42288.87},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44389.58},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29631.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29631.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":48249.55},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29631.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29631.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29631.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29631.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29631.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29631.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29631.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55465.87},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":50663.77},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29631.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft","code_information":[{"code":"933","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":35717.0,"maximum":75461.97,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57320.12},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35717.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35717.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":55797.47},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":57534.51},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":60392.55},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35717.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35717.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":65644.09},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35717.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35717.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35717.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35717.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35717.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35717.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35717.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":75461.97},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":68928.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35717.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Full Thickness Burn Without Skin Graft Or Inhalation Injury","code_information":[{"code":"934","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20503.26,"maximum":37423.15,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28426.23},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20503.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20503.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27671.12},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":28532.55},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29949.92},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20503.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20503.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":32554.26},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20503.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20503.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20503.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20503.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20503.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20503.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20503.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37423.15},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34183.15},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20503.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Extensive Burns","code_information":[{"code":"935","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19142.38,"maximum":38305.67,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29096.58},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19142.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19142.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28323.66},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":29205.41},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30656.2},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19142.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19142.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":33321.96},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19142.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19142.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19142.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19142.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19142.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19142.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19142.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38305.67},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34989.26},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19142.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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 With Mcc","code_information":[{"code":"939","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33316.02,"maximum":55354.25,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42046.5},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33316.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33316.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40929.58},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":42203.76},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44300.25},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33316.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33316.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":48152.45},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33316.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33316.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33316.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33316.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33316.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33316.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33316.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55354.25},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":50561.81},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33316.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23412.69,"10th_percentile":23412.69,"90th_percentile":23412.69,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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 With Cc","code_information":[{"code":"940","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21644.56,"maximum":36823.18,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27970.5},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21644.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21644.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27227.49},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":28075.12},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29469.76},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21644.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21644.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":32032.35},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21644.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21644.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21644.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21644.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21644.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21644.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21644.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36823.18},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33635.12},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21644.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":89200.58,"10th_percentile":89200.58,"90th_percentile":89200.58,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":18850.5,"maximum":34083.2,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25889.24},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18850.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18850.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25201.52},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":25986.07},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27276.94},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18850.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18850.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":29648.85},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18850.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18850.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18850.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18850.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18850.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18850.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18850.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34083.2},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31132.36},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18850.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":37532.72,"10th_percentile":37532.72,"90th_percentile":37532.72,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":52813.65,"10th_percentile":52813.65,"90th_percentile":52813.65,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":91219.98,"10th_percentile":89111.57,"90th_percentile":92091.25,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rehabilitation With Cc/Mcc","code_information":[{"code":"945","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14521.15,"maximum":26621.94,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20221.75},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14521.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14521.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19684.58},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":20297.38},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21305.66},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14521.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14521.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":23158.33},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14521.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14521.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14521.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14521.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14521.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14521.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14521.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26621.94},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24317.08},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14521.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":10890.31,"maximum":19471.13,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14790.07},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10890.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10890.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14397.18},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":14845.38},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15582.83},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10890.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10890.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":16937.86},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10890.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10890.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10890.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10890.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10890.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10890.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10890.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19471.13},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17785.37},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10890.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Signs And Symptoms With Mcc","code_information":[{"code":"947","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11998.17,"maximum":22430.87,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17038.25},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11998.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11998.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16585.65},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":17101.98},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17951.53},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11998.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11998.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":19512.53},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11998.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11998.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11998.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11998.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11998.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11998.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11998.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22430.87},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20488.86},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11998.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":948.34,"10th_percentile":948.34,"90th_percentile":948.34,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10125.25,"10th_percentile":10125.25,"90th_percentile":10183.14,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":98620.05,"10th_percentile":98620.05,"90th_percentile":98620.05,"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":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":62843.26,"10th_percentile":62843.26,"90th_percentile":62843.26,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":54174.61,"10th_percentile":54174.61,"90th_percentile":139472.92,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10134.14,"10th_percentile":10134.14,"90th_percentile":10134.14,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":6744.8,"10th_percentile":6744.8,"90th_percentile":6744.8,"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":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":22432.61,"10th_percentile":22432.61,"90th_percentile":22432.61,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10133.38,"10th_percentile":10133.38,"90th_percentile":10133.38,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":7760.99,"maximum":13856.87,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10525.54},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7760.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7760.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10245.94},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":10564.9},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11089.72},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7760.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7760.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":12054.04},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7760.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7760.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7760.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7760.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7760.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7760.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7760.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13856.87},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12657.18},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7760.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10605.02,"10th_percentile":10605.02,"90th_percentile":10605.02,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":4419.29,"10th_percentile":4419.29,"90th_percentile":4680.51,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6406.28,"10th_percentile":6406.28,"90th_percentile":6406.28,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":27834.81,"10th_percentile":13621.48,"90th_percentile":99787.39,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":35937.58,"10th_percentile":25751.73,"90th_percentile":90920.4,"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":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":1267.62,"10th_percentile":1267.62,"90th_percentile":4217.35,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6721.01,"10th_percentile":6721.01,"90th_percentile":6721.01,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"12","median_amount":39928.66,"10th_percentile":19104.22,"90th_percentile":82494.94,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":2934.69,"10th_percentile":2934.69,"90th_percentile":2934.69},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":5352.81,"10th_percentile":5352.81,"90th_percentile":5352.81,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6697.0,"10th_percentile":903.32,"90th_percentile":6697.01,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":5127.99,"10th_percentile":5096.16,"90th_percentile":11094.34,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":14379.43,"10th_percentile":14379.43,"90th_percentile":14379.43,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"1 through 10","median_amount":1082.0,"10th_percentile":1082.0,"90th_percentile":1082.0,"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":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6697.01,"10th_percentile":6697.01,"90th_percentile":6697.01,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare With Cc/Mcc","code_information":[{"code":"949","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11277.97,"maximum":18817.09,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14293.27},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11277.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11277.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13913.58},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":14346.73},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15059.4},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11277.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11277.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":16368.92},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11277.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11277.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11277.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11277.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11277.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11277.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11277.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18817.09},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17187.96},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11277.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":6199.5,"maximum":10222.17,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7764.65},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6199.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6199.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7558.39},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":7793.69},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8180.85},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6199.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6199.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":8892.23},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6199.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6199.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6199.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6199.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6199.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6199.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6199.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10222.17},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9337.16},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6199.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":18908.04,"10th_percentile":18908.04,"90th_percentile":18908.04,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Factors Influencing Health Status","code_information":[{"code":"951","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5551.59,"maximum":9887.3,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7510.29},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5551.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5551.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7310.79},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":7538.38},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7912.85},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5551.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5551.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":8600.93},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5551.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5551.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5551.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5551.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5551.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5551.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5551.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9887.3},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9031.28},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5551.59,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1896.68,"10th_percentile":1896.68,"90th_percentile":1896.68,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"1 through 10","median_amount":6675.41,"10th_percentile":6675.41,"90th_percentile":6675.41,"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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4607.86,"10th_percentile":4607.86,"90th_percentile":4607.86,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4537.22,"10th_percentile":4537.22,"90th_percentile":4537.22,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":6555.2,"10th_percentile":5643.62,"90th_percentile":84275.74,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1398.63,"10th_percentile":1398.63,"90th_percentile":2845.02,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":9697.2,"10th_percentile":9697.2,"90th_percentile":9697.2,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2845.02,"10th_percentile":2845.02,"90th_percentile":2845.02,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy For Multiple Significant Trauma","code_information":[{"code":"955","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":61352.44,"maximum":119085.4,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":90456.02},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61352.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61352.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":88053.14},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":90794.34},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":95304.58},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61352.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61352.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":103591.94},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61352.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61352.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61352.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61352.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61352.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61352.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61352.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":119085.4},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":108775.27},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61352.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":52105.12,"10th_percentile":52105.12,"90th_percentile":52105.12,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma","code_information":[{"code":"956","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":34531.42,"maximum":66662.99,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50636.51},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34531.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34531.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":49291.4},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":50825.9},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":53350.69},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34531.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34531.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":57989.88},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34531.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34531.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34531.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34531.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34531.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34531.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34531.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66662.99},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":60891.47},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34531.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":94880.08,"10th_percentile":94880.08,"90th_percentile":94880.08,"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":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":329057.94,"10th_percentile":329057.94,"90th_percentile":329057.94,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":31398.2,"10th_percentile":31398.2,"90th_percentile":31398.2,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Multiple Significant Trauma With Mcc","code_information":[{"code":"957","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":69384.02,"maximum":130174.39,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":98879.1},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":69384.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":69384.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":96252.47},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":99248.92},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":104179.15},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":69384.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":69384.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":113238.21},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":69384.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":69384.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":69384.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":69384.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":69384.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":69384.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":69384.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":130174.39},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":118904.2},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":69384.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":58228.37,"10th_percentile":58228.37,"90th_percentile":58228.37,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Multiple Significant Trauma With Cc","code_information":[{"code":"958","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":38605.94,"maximum":71673.79,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54442.66},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38605.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38605.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":52996.44},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":54646.28},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":57360.85},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38605.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38605.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":62348.76},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38605.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38605.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38605.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38605.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38605.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38605.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38605.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":71673.79},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":65468.44},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38605.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"1 through 10","median_amount":66679.02,"10th_percentile":66679.02,"90th_percentile":66679.02,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"New Technology - Level 22 ($2001-$2500)","code_information":[{"code":"1522","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"13","median_amount":8160.17,"10th_percentile":3753.55,"90th_percentile":8625.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1883.61,"10th_percentile":1883.61,"90th_percentile":1883.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"12","median_amount":2299.05,"10th_percentile":2201.05,"90th_percentile":2307.68,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1839.24,"10th_percentile":1839.24,"90th_percentile":1839.24,"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":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"1 through 10","median_amount":14506.56,"10th_percentile":13939.35,"90th_percentile":14521.56,"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":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"1 through 10","median_amount":30.0,"10th_percentile":30.0,"90th_percentile":30.0},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":1883.61,"10th_percentile":1808.42,"90th_percentile":1883.61,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2299.05,"10th_percentile":2216.89,"90th_percentile":2303.05,"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":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2138.11,"10th_percentile":2138.11,"90th_percentile":2138.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"31","median_amount":14506.56,"10th_percentile":13524.0,"90th_percentile":14600.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":2389.65,"10th_percentile":2249.53,"90th_percentile":2552.4},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1675.47,"10th_percentile":1675.47,"90th_percentile":1675.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2069.14,"10th_percentile":2069.14,"90th_percentile":2069.14,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"16","median_amount":2302.05,"10th_percentile":2106.05,"90th_percentile":2306.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2597.35,"10th_percentile":2597.35,"90th_percentile":2597.35,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1883.61,"10th_percentile":1808.42,"90th_percentile":1883.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1883.61,"10th_percentile":1839.24,"90th_percentile":1883.61,"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":"Molina Healthcare","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":1708.98,"10th_percentile":1708.98,"90th_percentile":1708.98,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"1 through 10","median_amount":3754.1,"10th_percentile":3754.1,"90th_percentile":3754.1,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"1 through 10","median_amount":4694.0,"10th_percentile":4694.0,"90th_percentile":4694.0,"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":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"13","median_amount":2299.06,"10th_percentile":1883.61,"90th_percentile":2484.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endo, single, urinary tract","code_information":[{"code":"2040","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"1 through 10","median_amount":14647.5,"10th_percentile":14647.5,"90th_percentile":14647.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6195.18,"10th_percentile":6195.18,"90th_percentile":6195.18,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"1 through 10","median_amount":40852.07,"10th_percentile":40852.07,"90th_percentile":85080.19},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4829.75,"10th_percentile":4829.75,"90th_percentile":4829.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"1 through 10","median_amount":42992.98,"10th_percentile":32848.82,"90th_percentile":90048.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":15199.66,"10th_percentile":15199.66,"90th_percentile":15199.66},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6213.58,"10th_percentile":6213.58,"90th_percentile":6213.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","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":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"1 through 10","median_amount":8836.5,"10th_percentile":8836.5,"90th_percentile":10202.0,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6429.21,"10th_percentile":6199.9,"90th_percentile":6491.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cath coronary drug-delivery","code_information":[{"code":"2050","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"1 through 10","median_amount":40220.86,"10th_percentile":40220.86,"90th_percentile":40220.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":3466.84,"10th_percentile":3466.84,"90th_percentile":3466.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"1 through 10","median_amount":99411.81,"10th_percentile":99411.81,"90th_percentile":99411.81,"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":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"1 through 10","median_amount":92982.14,"10th_percentile":92982.14,"90th_percentile":92982.14},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"1 through 10","median_amount":157578.25,"10th_percentile":157578.25,"90th_percentile":157578.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":12371.74,"10th_percentile":12371.74,"90th_percentile":12371.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","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":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":12273.76,"10th_percentile":12273.76,"90th_percentile":12273.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Brachytx, non-str,Yttrium-90","code_information":[{"code":"2616","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":28720.61,"10th_percentile":28708.61,"90th_percentile":28768.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":34982.08,"10th_percentile":34982.08,"90th_percentile":34982.08,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","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":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Clinic Visits and Related Services","code_information":[{"code":"5012","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"518","median_amount":81.6,"10th_percentile":6.86,"90th_percentile":121.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"513","median_amount":190.55,"10th_percentile":164.87,"90th_percentile":301.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1541","median_amount":131.65,"10th_percentile":105.32,"90th_percentile":132.45,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"436","median_amount":132.19,"10th_percentile":49.16,"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":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"611","median_amount":193.0,"10th_percentile":129.0,"90th_percentile":214.94,"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":"BCBS","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"854","median_amount":8.83,"10th_percentile":8.83,"90th_percentile":20.0},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":"438","median_amount":179.46,"10th_percentile":140.0,"90th_percentile":264.0,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"376","median_amount":131.65,"10th_percentile":124.23,"90th_percentile":132.19,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"3828","median_amount":122.44,"10th_percentile":122.44,"90th_percentile":172.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"2912","median_amount":193.0,"10th_percentile":129.0,"90th_percentile":241.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"461","median_amount":67.55,"10th_percentile":39.77,"90th_percentile":115.8},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"21","median_amount":131.65,"10th_percentile":4.29,"90th_percentile":152.75,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":131.65,"10th_percentile":131.65,"90th_percentile":131.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"339","median_amount":164.87,"10th_percentile":129.7,"90th_percentile":236.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"19","median_amount":118.49,"10th_percentile":118.49,"90th_percentile":118.49,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1496","median_amount":131.65,"10th_percentile":131.65,"90th_percentile":131.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1768","median_amount":132.0,"10th_percentile":129.7,"90th_percentile":212.82,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":131.65,"10th_percentile":131.65,"90th_percentile":131.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1100","median_amount":182.08,"10th_percentile":140.0,"90th_percentile":238.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"350","median_amount":132.0,"10th_percentile":13.12,"90th_percentile":210.05,"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 Healthcare","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":"101","median_amount":178.31,"10th_percentile":140.0,"90th_percentile":231.83,"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":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"547","median_amount":182.0,"10th_percentile":92.4,"90th_percentile":217.0,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"80","median_amount":193.0,"10th_percentile":90.16,"90th_percentile":274.0,"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":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1804","median_amount":131.66,"10th_percentile":124.24,"90th_percentile":132.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":107.38,"10th_percentile":103.88,"90th_percentile":139.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 1 Type A ED Visits","code_information":[{"code":"5021","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"48","median_amount":612.0,"10th_percentile":254.16,"90th_percentile":1190.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"49","median_amount":215.53,"10th_percentile":206.88,"90th_percentile":423.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"15","median_amount":91.79,"10th_percentile":91.79,"90th_percentile":158.71,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":18.36,"10th_percentile":18.36,"90th_percentile":18.36,"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":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"37","median_amount":698.54,"10th_percentile":440.0,"90th_percentile":1284.82,"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":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"67","median_amount":770.0,"10th_percentile":340.0,"90th_percentile":1315.0},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":"77","median_amount":215.53,"10th_percentile":199.75,"90th_percentile":353.69,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":89.95,"10th_percentile":3.11,"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":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":85.36,"10th_percentile":56.44,"90th_percentile":251.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"296","median_amount":779.0,"10th_percentile":425.76,"90th_percentile":1238.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"30","median_amount":269.5,"10th_percentile":125.18,"90th_percentile":460.25},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":307.65,"10th_percentile":307.65,"90th_percentile":307.65,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"74","median_amount":215.53,"10th_percentile":184.42,"90th_percentile":314.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"18","median_amount":91.79,"10th_percentile":89.95,"90th_percentile":231.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":156.01,"10th_percentile":156.01,"90th_percentile":156.01,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"121","median_amount":215.53,"10th_percentile":198.58,"90th_percentile":423.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":90.32,"10th_percentile":90.32,"90th_percentile":90.32,"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":"Molina Healthcare","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":182.13,"10th_percentile":154.07,"90th_percentile":486.6,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"73","median_amount":816.1,"10th_percentile":214.0,"90th_percentile":1315.0,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"1 through 10","median_amount":556.76,"10th_percentile":232.0,"90th_percentile":1382.0,"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":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"29","median_amount":91.76,"10th_percentile":73.43,"90th_percentile":141.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":214.36,"10th_percentile":214.36,"90th_percentile":214.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 2 Type A ED Visits","code_information":[{"code":"5022","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"165","median_amount":919.0,"10th_percentile":247.25,"90th_percentile":2245.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"88","median_amount":227.16,"10th_percentile":173.6,"90th_percentile":602.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"140","median_amount":164.28,"10th_percentile":131.32,"90th_percentile":393.58,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":129.42,"10th_percentile":129.42,"90th_percentile":152.06,"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":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"109","median_amount":1249.0,"10th_percentile":866.69,"90th_percentile":2599.0,"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":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"217","median_amount":1365.0,"10th_percentile":819.0,"90th_percentile":2982.0},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":"209","median_amount":216.53,"10th_percentile":157.82,"90th_percentile":471.55,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"27","median_amount":268.68,"10th_percentile":161.78,"90th_percentile":393.68,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"24","median_amount":153.52,"10th_percentile":145.87,"90th_percentile":366.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"867","median_amount":1358.0,"10th_percentile":851.0,"90th_percentile":2782.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"78","median_amount":592.9,"10th_percentile":303.25,"90th_percentile":864.0},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":252.76,"10th_percentile":138.62,"90th_percentile":573.01,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"145","median_amount":214.36,"10th_percentile":153.31,"90th_percentile":477.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":155.17,"10th_percentile":155.17,"90th_percentile":226.56,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"105","median_amount":164.58,"10th_percentile":24.58,"90th_percentile":393.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"12","median_amount":205.84,"10th_percentile":111.09,"90th_percentile":312.93,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":242.77,"10th_percentile":242.77,"90th_percentile":242.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"307","median_amount":215.53,"10th_percentile":157.82,"90th_percentile":445.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"19","median_amount":162.44,"10th_percentile":162.44,"90th_percentile":257.22,"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":"Molina Healthcare","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":238.52,"10th_percentile":160.98,"90th_percentile":458.01,"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":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"158","median_amount":1171.45,"10th_percentile":460.0,"90th_percentile":1513.0,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"23","median_amount":1244.0,"10th_percentile":794.0,"90th_percentile":1382.0,"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":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"111","median_amount":164.28,"10th_percentile":73.58,"90th_percentile":392.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":228.88,"10th_percentile":199.75,"90th_percentile":640.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 3 Type A ED Visits","code_information":[{"code":"5023","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"731","median_amount":2035.73,"10th_percentile":608.68,"90th_percentile":3171.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"412","median_amount":293.45,"10th_percentile":179.46,"90th_percentile":815.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"498","median_amount":391.5,"10th_percentile":266.59,"90th_percentile":637.7,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"15","median_amount":284.02,"10th_percentile":226.29,"90th_percentile":393.1,"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":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"447","median_amount":2623.18,"10th_percentile":1599.9,"90th_percentile":5616.53,"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":"BCBS","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"957","median_amount":2505.03,"10th_percentile":1665.0,"90th_percentile":5585.0},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":"868","median_amount":256.56,"10th_percentile":187.79,"90th_percentile":747.02,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"113","median_amount":389.77,"10th_percentile":175.07,"90th_percentile":602.22,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"66","median_amount":352.09,"10th_percentile":254.48,"90th_percentile":599.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"3233","median_amount":2607.0,"10th_percentile":1665.0,"90th_percentile":5565.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"420","median_amount":829.5,"10th_percentile":551.23,"90th_percentile":1925.35},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"41","median_amount":372.93,"10th_percentile":160.37,"90th_percentile":642.82,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":284.62,"10th_percentile":282.87,"90th_percentile":1730.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"644","median_amount":262.79,"10th_percentile":173.77,"90th_percentile":778.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":328.3,"10th_percentile":250.78,"90th_percentile":931.82,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"518","median_amount":374.12,"10th_percentile":145.67,"90th_percentile":665.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"29","median_amount":331.81,"10th_percentile":111.09,"90th_percentile":630.96,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":404.8,"10th_percentile":404.8,"90th_percentile":994.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1268","median_amount":259.48,"10th_percentile":183.64,"90th_percentile":706.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"39","median_amount":338.11,"10th_percentile":226.29,"90th_percentile":593.54,"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":"Molina Healthcare","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":"209","median_amount":287.36,"10th_percentile":172.01,"90th_percentile":661.19,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"704","median_amount":1513.0,"10th_percentile":663.0,"90th_percentile":1513.0,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"68","median_amount":1382.0,"10th_percentile":579.85,"90th_percentile":1382.0,"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":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"482","median_amount":374.13,"10th_percentile":194.67,"90th_percentile":604.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"19","median_amount":220.49,"10th_percentile":190.65,"90th_percentile":815.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 4 Type A ED Visits","code_information":[{"code":"5024","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"1475","median_amount":2910.0,"10th_percentile":1061.62,"90th_percentile":3812.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"726","median_amount":551.46,"10th_percentile":198.58,"90th_percentile":1266.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1178","median_amount":667.24,"10th_percentile":285.37,"90th_percentile":1095.56,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"31","median_amount":434.91,"10th_percentile":348.0,"90th_percentile":842.08,"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":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"979","median_amount":5202.54,"10th_percentile":2893.56,"90th_percentile":10428.83,"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":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"1941","median_amount":5031.0,"10th_percentile":3022.15,"90th_percentile":10088.54},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"1 through 10","median_amount":4572.0,"10th_percentile":3837.94,"90th_percentile":22112.07,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1516","median_amount":433.43,"10th_percentile":198.58,"90th_percentile":1218.17,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"274","median_amount":667.23,"10th_percentile":436.0,"90th_percentile":1097.25,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"207","median_amount":643.85,"10th_percentile":406.27,"90th_percentile":1054.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"6621","median_amount":4924.9,"10th_percentile":2879.31,"90th_percentile":10017.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"740","median_amount":1610.45,"10th_percentile":919.27,"90th_percentile":3197.0},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"81","median_amount":743.0,"10th_percentile":437.8,"90th_percentile":1240.91,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":791.44,"10th_percentile":656.31,"90th_percentile":1345.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1117","median_amount":442.61,"10th_percentile":192.91,"90th_percentile":1181.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"37","median_amount":602.17,"10th_percentile":355.15,"90th_percentile":1016.49,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1275","median_amount":650.24,"10th_percentile":272.49,"90th_percentile":1069.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"53","median_amount":671.42,"10th_percentile":319.15,"90th_percentile":1191.37,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":556.6,"10th_percentile":327.2,"90th_percentile":928.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"2211","median_amount":442.17,"10th_percentile":198.58,"90th_percentile":1181.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"113","median_amount":668.58,"10th_percentile":348.0,"90th_percentile":991.65,"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 Healthcare","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":"341","median_amount":414.39,"10th_percentile":195.1,"90th_percentile":1225.66,"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":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"1510","median_amount":1513.0,"10th_percentile":753.58,"90th_percentile":1513.0,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"176","median_amount":1382.0,"10th_percentile":679.2,"90th_percentile":1382.0,"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":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1100","median_amount":667.55,"10th_percentile":313.19,"90th_percentile":1110.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"28","median_amount":406.27,"10th_percentile":192.09,"90th_percentile":866.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 5 Type A ED Visits","code_information":[{"code":"5025","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"524","median_amount":3210.0,"10th_percentile":1826.02,"90th_percentile":7264.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"358","median_amount":863.64,"10th_percentile":343.59,"90th_percentile":1960.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"770","median_amount":1592.05,"10th_percentile":586.79,"90th_percentile":2711.85,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"57","median_amount":853.72,"10th_percentile":501.06,"90th_percentile":2715.89,"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":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"333","median_amount":10223.83,"10th_percentile":5366.34,"90th_percentile":26671.99,"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":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"586","median_amount":9765.89,"10th_percentile":5188.46,"90th_percentile":21576.77},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"1 through 10","median_amount":4343.41,"10th_percentile":4343.41,"90th_percentile":4343.41,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"607","median_amount":801.68,"10th_percentile":289.96,"90th_percentile":1676.83,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"157","median_amount":1343.49,"10th_percentile":719.07,"90th_percentile":2881.4,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"133","median_amount":1187.23,"10th_percentile":695.4,"90th_percentile":2566.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"2056","median_amount":10025.2,"10th_percentile":5351.8,"90th_percentile":23324.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"259","median_amount":2981.96,"10th_percentile":1300.58,"90th_percentile":8056.95},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"56","median_amount":1163.48,"10th_percentile":698.6,"90th_percentile":2780.83,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2616.65,"10th_percentile":2616.65,"90th_percentile":2616.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"418","median_amount":813.03,"10th_percentile":292.08,"90th_percentile":2454.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"12","median_amount":2420.17,"10th_percentile":881.49,"90th_percentile":2505.07,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"847","median_amount":1401.29,"10th_percentile":535.46,"90th_percentile":2881.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"57","median_amount":742.28,"10th_percentile":306.0,"90th_percentile":2661.57,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"41","median_amount":837.88,"10th_percentile":518.53,"90th_percentile":2597.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"838","median_amount":858.8,"10th_percentile":300.66,"90th_percentile":2041.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"103","median_amount":969.45,"10th_percentile":580.59,"90th_percentile":2164.15,"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":"Molina Healthcare","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":"105","median_amount":712.05,"10th_percentile":360.76,"90th_percentile":1892.48,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"516","median_amount":1513.0,"10th_percentile":1059.44,"90th_percentile":4356.0,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"79","median_amount":1428.16,"10th_percentile":905.6,"90th_percentile":4356.74,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"759","median_amount":1378.62,"10th_percentile":593.39,"90th_percentile":2707.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"45","median_amount":480.66,"10th_percentile":324.83,"90th_percentile":754.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Critical Care","code_information":[{"code":"5041","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"26","median_amount":3123.0,"10th_percentile":847.37,"90th_percentile":6444.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"17","median_amount":1165.77,"10th_percentile":556.37,"90th_percentile":2467.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"32","median_amount":1845.09,"10th_percentile":1056.4,"90th_percentile":2725.47,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1632.96,"10th_percentile":1632.96,"90th_percentile":1632.96,"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":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"16","median_amount":9751.94,"10th_percentile":6671.56,"90th_percentile":28334.93,"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":"BCBS","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"28","median_amount":9182.94,"10th_percentile":5277.9,"90th_percentile":20923.53},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":882.6,"10th_percentile":369.43,"90th_percentile":2720.81,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1402.74,"10th_percentile":1125.66,"90th_percentile":2894.52,"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":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1375.5,"10th_percentile":1201.75,"90th_percentile":1972.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"104","median_amount":10082.5,"10th_percentile":5075.61,"90th_percentile":29608.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"14","median_amount":2296.73,"10th_percentile":1655.0,"90th_percentile":5654.26},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1523.94,"10th_percentile":1374.37,"90th_percentile":2477.88,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"22","median_amount":764.72,"10th_percentile":556.37,"90th_percentile":1378.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"32","median_amount":2513.75,"10th_percentile":1140.42,"90th_percentile":2885.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":959.05,"10th_percentile":959.05,"90th_percentile":959.05,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2173.66,"10th_percentile":2173.66,"90th_percentile":2173.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"51","median_amount":605.74,"10th_percentile":304.77,"90th_percentile":1486.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2058.04,"10th_percentile":2058.04,"90th_percentile":2058.04,"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 Healthcare","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":624.02,"10th_percentile":574.22,"90th_percentile":2553.58,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"26","median_amount":1513.45,"10th_percentile":1296.1,"90th_percentile":4356.0,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"1 through 10","median_amount":3978.0,"10th_percentile":1382.0,"90th_percentile":8966.22,"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":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"18","median_amount":2121.14,"10th_percentile":1170.31,"90th_percentile":2720.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1285.23,"10th_percentile":1285.23,"90th_percentile":1285.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Trauma Response with Critical Care","code_information":[{"code":"5045","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1217.26,"10th_percentile":1217.26,"90th_percentile":1217.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"1 through 10","median_amount":40142.59,"10th_percentile":40142.59,"90th_percentile":40142.59,"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":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"1 through 10","median_amount":33306.67,"10th_percentile":33306.67,"90th_percentile":33306.67},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":1680.34,"10th_percentile":900.88,"90th_percentile":5000.0,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"1 through 10","median_amount":21477.89,"10th_percentile":13258.39,"90th_percentile":45132.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":11076.53,"10th_percentile":11076.53,"90th_percentile":12011.29},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":9092.87,"10th_percentile":9092.87,"90th_percentile":9092.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2075.29,"10th_percentile":2075.29,"90th_percentile":2075.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1044.12,"10th_percentile":1044.12,"90th_percentile":1044.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","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":918.36,"10th_percentile":918.36,"90th_percentile":918.36,"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":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"1 through 10","median_amount":5000.0,"10th_percentile":1513.0,"90th_percentile":10970.4,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"1 through 10","median_amount":40966.52,"10th_percentile":40966.52,"90th_percentile":40966.52,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3440.44,"10th_percentile":3440.44,"90th_percentile":3440.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":961.24,"10th_percentile":961.24,"90th_percentile":961.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 1 Skin Procedures","code_information":[{"code":"5051","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"70","median_amount":402.44,"10th_percentile":193.33,"90th_percentile":2735.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"32","median_amount":207.33,"10th_percentile":135.81,"90th_percentile":469.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"61","median_amount":266.59,"10th_percentile":196.3,"90th_percentile":687.05,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"12","median_amount":203.82,"10th_percentile":140.95,"90th_percentile":210.64,"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":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"48","median_amount":1068.0,"10th_percentile":212.0,"90th_percentile":3165.19,"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":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"52","median_amount":1465.0,"10th_percentile":20.0,"90th_percentile":3778.53},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":441.17,"10th_percentile":199.56,"90th_percentile":657.82,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"26","median_amount":295.65,"10th_percentile":164.28,"90th_percentile":615.96,"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":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"48","median_amount":188.78,"10th_percentile":122.44,"90th_percentile":332.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"330","median_amount":1024.0,"10th_percentile":200.0,"90th_percentile":3453.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"28","median_amount":493.6,"10th_percentile":72.1,"90th_percentile":1132.04},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":202.99,"10th_percentile":145.67,"90th_percentile":488.66,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":196.0,"10th_percentile":196.0,"90th_percentile":196.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"25","median_amount":325.27,"10th_percentile":90.54,"90th_percentile":470.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"83","median_amount":282.87,"10th_percentile":98.35,"90th_percentile":591.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"20","median_amount":504.85,"10th_percentile":199.05,"90th_percentile":623.89,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"64","median_amount":206.0,"10th_percentile":90.54,"90th_percentile":469.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":295.65,"10th_percentile":203.82,"90th_percentile":501.06,"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 Healthcare","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":"19","median_amount":92.36,"10th_percentile":46.18,"90th_percentile":478.68,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"84","median_amount":574.08,"10th_percentile":203.82,"90th_percentile":1513.0,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"1 through 10","median_amount":905.6,"10th_percentile":711.0,"90th_percentile":2366.0,"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":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"61","median_amount":285.37,"10th_percentile":157.04,"90th_percentile":657.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Skin Procedures","code_information":[{"code":"5052","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"28","median_amount":1762.87,"10th_percentile":456.0,"90th_percentile":7637.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"11","median_amount":719.82,"10th_percentile":199.05,"90th_percentile":1083.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"17","median_amount":553.82,"10th_percentile":408.15,"90th_percentile":802.05,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":495.46,"10th_percentile":11.14,"90th_percentile":924.17,"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":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"13","median_amount":1829.67,"10th_percentile":883.0,"90th_percentile":4967.73,"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":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"12","median_amount":2553.48,"10th_percentile":35.73,"90th_percentile":13557.74},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":441.17,"10th_percentile":410.4,"90th_percentile":6324.78,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":612.23,"10th_percentile":408.15,"90th_percentile":1000.54,"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":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"18","median_amount":379.58,"10th_percentile":122.44,"90th_percentile":502.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"98","median_amount":2250.07,"10th_percentile":456.0,"90th_percentile":11157.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":830.13,"10th_percentile":456.0,"90th_percentile":5786.47},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":665.46,"10th_percentile":342.42,"90th_percentile":1563.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"16","median_amount":411.15,"10th_percentile":408.15,"90th_percentile":704.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":521.92,"10th_percentile":502.67,"90th_percentile":753.04,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"18","median_amount":452.89,"10th_percentile":351.53,"90th_percentile":693.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":409.82,"10th_percentile":87.42,"90th_percentile":410.8,"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 Healthcare","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":211.48,"10th_percentile":211.48,"90th_percentile":450.0,"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":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"19","median_amount":432.0,"10th_percentile":388.79,"90th_percentile":1513.0,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"1 through 10","median_amount":393.0,"10th_percentile":393.0,"90th_percentile":589.5,"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":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":617.24,"10th_percentile":326.52,"90th_percentile":1099.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Skin Procedures","code_information":[{"code":"5053","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"43","median_amount":900.0,"10th_percentile":638.4,"90th_percentile":1972.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1184.8,"10th_percentile":720.56,"90th_percentile":1448.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"157","median_amount":627.89,"10th_percentile":625.34,"90th_percentile":941.84,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"29","median_amount":1344.0,"10th_percentile":865.44,"90th_percentile":3132.0,"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":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"1 through 10","median_amount":22195.55,"10th_percentile":15323.78,"90th_percentile":25975.86},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":900.0,"10th_percentile":479.4,"90th_percentile":1448.8,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"34","median_amount":684.34,"10th_percentile":625.34,"90th_percentile":938.01,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"234","median_amount":1344.0,"10th_percentile":900.0,"90th_percentile":3316.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"19","median_amount":534.8,"10th_percentile":315.0,"90th_percentile":781.2},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":576.34,"10th_percentile":421.67,"90th_percentile":891.34,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":900.0,"10th_percentile":512.93,"90th_percentile":1390.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":844.21,"10th_percentile":562.8,"90th_percentile":844.21,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"82","median_amount":625.34,"10th_percentile":625.34,"90th_percentile":938.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1169.1,"10th_percentile":1169.1,"90th_percentile":1169.1,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"11","median_amount":900.0,"10th_percentile":528.01,"90th_percentile":1448.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":627.89,"10th_percentile":627.89,"90th_percentile":627.89,"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":"Molina Healthcare","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":1982.99,"10th_percentile":1982.99,"90th_percentile":1982.99,"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":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"49","median_amount":632.84,"10th_percentile":412.0,"90th_percentile":873.35,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"1 through 10","median_amount":393.0,"10th_percentile":26.14,"90th_percentile":687.75,"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":"[APC ($): FEE SCHEDULE]","count":"89","median_amount":625.34,"10th_percentile":625.34,"90th_percentile":938.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Skin Procedures","code_information":[{"code":"5054","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"28","median_amount":3168.0,"10th_percentile":1701.73,"90th_percentile":8400.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2244.88,"10th_percentile":2244.88,"90th_percentile":3367.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"66","median_amount":2181.36,"10th_percentile":1874.25,"90th_percentile":2190.27,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"11","median_amount":3612.0,"10th_percentile":2085.0,"90th_percentile":20351.6,"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":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"13","median_amount":14706.76,"10th_percentile":11026.24,"90th_percentile":19419.08},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":2340.98,"10th_percentile":2340.98,"90th_percentile":2438.31,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2181.36,"10th_percentile":1876.19,"90th_percentile":2449.34,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"90","median_amount":3216.0,"10th_percentile":2877.18,"90th_percentile":16495.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":1882.3,"10th_percentile":1108.8,"90th_percentile":12247.67},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2181.36,"10th_percentile":2181.36,"90th_percentile":2187.86,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2155.26,"10th_percentile":765.64,"90th_percentile":2474.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1963.24,"10th_percentile":1963.24,"90th_percentile":1963.24,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"67","median_amount":2181.36,"10th_percentile":1868.69,"90th_percentile":2181.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2724.0,"10th_percentile":2724.0,"90th_percentile":4378.85,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"19","median_amount":2438.31,"10th_percentile":1462.09,"90th_percentile":3623.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1876.32,"10th_percentile":1876.32,"90th_percentile":1876.32,"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":"Molina Healthcare","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":2487.08,"10th_percentile":2487.08,"90th_percentile":2487.08,"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":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"31","median_amount":2868.0,"10th_percentile":2217.6,"90th_percentile":2988.0,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"1 through 10","median_amount":2729.75,"10th_percentile":2729.75,"90th_percentile":3570.15,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"34","median_amount":2181.37,"10th_percentile":1818.82,"90th_percentile":2494.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 5 Skin Procedures","code_information":[{"code":"5055","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"1 through 10","median_amount":14536.5,"10th_percentile":14536.5,"90th_percentile":14536.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":4075.0,"10th_percentile":4075.0,"90th_percentile":4075.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3747.44,"10th_percentile":3747.44,"90th_percentile":4052.61,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"1 through 10","median_amount":5492.0,"10th_percentile":5492.0,"90th_percentile":5492.0,"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":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"1 through 10","median_amount":29205.77,"10th_percentile":19503.08,"90th_percentile":34852.4},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":3230.32,"10th_percentile":3230.32,"90th_percentile":3230.32,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4052.61,"10th_percentile":4052.61,"90th_percentile":4052.61,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"20","median_amount":26046.48,"10th_percentile":10295.27,"90th_percentile":48106.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":11247.61,"10th_percentile":11247.61,"90th_percentile":11247.61},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4052.61,"10th_percentile":4052.61,"90th_percentile":4052.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2438.31,"10th_percentile":1955.0,"90th_percentile":2438.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","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":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"1 through 10","median_amount":3370.0,"10th_percentile":3370.0,"90th_percentile":3370.0,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4052.62,"10th_percentile":4052.62,"90th_percentile":4052.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Excision/ Biopsy/ Incision and Drainage","code_information":[{"code":"5071","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"99","median_amount":2596.99,"10th_percentile":804.0,"90th_percentile":5336.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"20","median_amount":857.53,"10th_percentile":771.78,"90th_percentile":1760.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"91","median_amount":725.77,"10th_percentile":718.77,"90th_percentile":827.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":550.11,"10th_percentile":550.11,"90th_percentile":550.11,"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":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"81","median_amount":3184.31,"10th_percentile":1188.0,"90th_percentile":5933.0,"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":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"146","median_amount":3551.58,"10th_percentile":2473.0,"90th_percentile":6963.58},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":857.53,"10th_percentile":441.17,"90th_percentile":1495.34,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"26","median_amount":726.27,"10th_percentile":539.54,"90th_percentile":861.83,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":668.46,"10th_percentile":668.46,"90th_percentile":771.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"431","median_amount":3418.0,"10th_percentile":1204.67,"90th_percentile":5896.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"41","median_amount":1052.1,"10th_percentile":734.03,"90th_percentile":1714.31},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":732.98,"10th_percentile":693.95,"90th_percentile":808.28,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"11","median_amount":823.3,"10th_percentile":823.3,"90th_percentile":4712.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":651.9,"10th_percentile":651.9,"90th_percentile":836.07,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"115","median_amount":721.77,"10th_percentile":571.77,"90th_percentile":819.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1151.06,"10th_percentile":948.87,"90th_percentile":1452.33,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"36","median_amount":857.53,"10th_percentile":441.17,"90th_percentile":1690.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":721.7,"10th_percentile":663.94,"90th_percentile":721.7,"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":"Molina Healthcare","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":538.57,"10th_percentile":517.07,"90th_percentile":1972.78,"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":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"91","median_amount":1123.0,"10th_percentile":807.34,"90th_percentile":1339.0,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"1 through 10","median_amount":1025.0,"10th_percentile":977.2,"90th_percentile":1221.5,"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":"[APC ($): FEE SCHEDULE]","count":"52","median_amount":721.71,"10th_percentile":488.48,"90th_percentile":822.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Excision/ Biopsy/ Incision and Drainage","code_information":[{"code":"5072","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"238","median_amount":5035.04,"10th_percentile":2180.4,"90th_percentile":8414.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"50","median_amount":1670.6,"10th_percentile":906.05,"90th_percentile":2521.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"127","median_amount":1660.26,"10th_percentile":1496.12,"90th_percentile":1763.56,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"157","median_amount":6922.54,"10th_percentile":5028.85,"90th_percentile":14145.23,"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":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"323","median_amount":6612.94,"10th_percentile":5116.67,"90th_percentile":12721.35},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":1670.6,"10th_percentile":100.46,"90th_percentile":2701.73,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"24","median_amount":1661.19,"10th_percentile":1523.58,"90th_percentile":1757.78,"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":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"12","median_amount":1539.33,"10th_percentile":1539.33,"90th_percentile":1760.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"1037","median_amount":6553.54,"10th_percentile":5155.8,"90th_percentile":12472.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"142","median_amount":2274.62,"10th_percentile":1220.26,"90th_percentile":4103.36},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1628.94,"10th_percentile":1312.19,"90th_percentile":1661.69,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"30","median_amount":1518.74,"10th_percentile":869.88,"90th_percentile":1765.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1496.17,"10th_percentile":1496.17,"90th_percentile":1571.99,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"178","median_amount":1655.19,"10th_percentile":1263.19,"90th_percentile":1749.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2035.88,"10th_percentile":1809.28,"90th_percentile":2080.33,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1760.56,"10th_percentile":1760.56,"90th_percentile":1760.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"91","median_amount":1690.28,"10th_percentile":869.88,"90th_percentile":2244.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1661.95,"10th_percentile":13.12,"90th_percentile":4043.55,"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 Healthcare","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":1724.09,"10th_percentile":1504.88,"90th_percentile":2292.16,"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":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"240","median_amount":2664.0,"10th_percentile":1300.0,"90th_percentile":2880.0,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"33","median_amount":2316.0,"10th_percentile":1025.0,"90th_percentile":2435.0,"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":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"95","median_amount":1655.7,"10th_percentile":1324.16,"90th_percentile":1756.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Excision/ Biopsy/ Incision and Drainage","code_information":[{"code":"5073","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"39","median_amount":6628.89,"10th_percentile":4524.0,"90th_percentile":11443.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"18","median_amount":2907.07,"10th_percentile":2244.88,"90th_percentile":4360.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"21","median_amount":2923.79,"10th_percentile":2638.97,"90th_percentile":2932.74,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"29","median_amount":17346.2,"10th_percentile":10310.58,"90th_percentile":24867.18,"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":"BCBS","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"65","median_amount":18558.92,"10th_percentile":11186.04,"90th_percentile":26361.8},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":2791.03,"10th_percentile":2247.22,"90th_percentile":2907.62,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2923.79,"10th_percentile":2923.79,"90th_percentile":2931.29,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2719.13,"10th_percentile":2719.13,"90th_percentile":2907.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"186","median_amount":19631.59,"10th_percentile":10113.33,"90th_percentile":31136.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"26","median_amount":5336.71,"10th_percentile":3080.54,"90th_percentile":9566.42},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2930.29,"10th_percentile":2930.29,"90th_percentile":2930.29,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"15","median_amount":2791.03,"10th_percentile":2157.51,"90th_percentile":4360.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2926.79,"10th_percentile":2776.79,"90th_percentile":7795.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3259.98,"10th_percentile":3259.98,"90th_percentile":3259.98,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"37","median_amount":2907.07,"10th_percentile":2247.22,"90th_percentile":4360.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","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":2387.8,"10th_percentile":2387.8,"90th_percentile":2965.21,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"42","median_amount":5810.68,"10th_percentile":2664.0,"90th_percentile":7381.12,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"1 through 10","median_amount":5380.0,"10th_percentile":5380.0,"90th_percentile":5425.02,"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":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2923.8,"10th_percentile":2678.46,"90th_percentile":2935.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Breast/Lymphatic Surgery and Related Procedures","code_information":[{"code":"5091","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"54","median_amount":6388.0,"10th_percentile":5282.15,"90th_percentile":14003.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"13","median_amount":6080.5,"10th_percentile":3831.47,"90th_percentile":7185.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"40","median_amount":3914.82,"10th_percentile":3568.89,"90th_percentile":6662.92,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"40","median_amount":21698.19,"10th_percentile":11183.01,"90th_percentile":33391.16,"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":"BCBS","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"62","median_amount":19121.2,"10th_percentile":11423.18,"90th_percentile":29658.12},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"1 through 10","median_amount":27454.83,"10th_percentile":27454.83,"90th_percentile":27454.83,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":1670.6,"10th_percentile":1603.91,"90th_percentile":3990.78,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3917.89,"10th_percentile":3915.88,"90th_percentile":6662.14,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6195.79,"10th_percentile":6195.79,"90th_percentile":6195.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"191","median_amount":16994.5,"10th_percentile":11222.73,"90th_percentile":29372.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"24","median_amount":7233.2,"10th_percentile":4267.54,"90th_percentile":11638.76},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3753.39,"10th_percentile":3753.39,"90th_percentile":3753.39,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":3922.03,"10th_percentile":1670.6,"90th_percentile":6898.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3525.7,"10th_percentile":3525.7,"90th_percentile":3525.7,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"42","median_amount":3914.89,"10th_percentile":3617.89,"90th_percentile":6662.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"16","median_amount":5575.44,"10th_percentile":1670.6,"90th_percentile":7185.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","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":1704.01,"10th_percentile":1704.01,"90th_percentile":1704.01,"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":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"52","median_amount":5891.0,"10th_percentile":5103.0,"90th_percentile":9696.25,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"1 through 10","median_amount":5380.0,"10th_percentile":4305.34,"90th_percentile":9049.21,"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":"[APC ($): FEE SCHEDULE]","count":"19","median_amount":3916.89,"10th_percentile":3590.33,"90th_percentile":6667.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Breast/Lymphatic Surgery and Related Procedures","code_information":[{"code":"5092","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"36","median_amount":9686.0,"10th_percentile":6596.0,"90th_percentile":17337.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":13062.48,"10th_percentile":6343.31,"90th_percentile":13605.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6662.14,"10th_percentile":6319.14,"90th_percentile":6672.58,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"20","median_amount":28796.95,"10th_percentile":23747.37,"90th_percentile":44451.84,"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":"BCBS","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"47","median_amount":30445.1,"10th_percentile":26606.37,"90th_percentile":40403.2},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"1 through 10","median_amount":39437.27,"10th_percentile":39437.27,"90th_percentile":39437.27,"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":"BCBS","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":13217.12,"10th_percentile":6127.66,"90th_percentile":13605.61,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6662.14,"10th_percentile":6662.14,"90th_percentile":6662.14,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"200","median_amount":29947.73,"10th_percentile":20249.54,"90th_percentile":40924.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"23","median_amount":10181.05,"10th_percentile":7764.28,"90th_percentile":12783.85},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":13605.61,"10th_percentile":13605.61,"90th_percentile":13605.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6610.14,"10th_percentile":6515.14,"90th_percentile":8135.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"11","median_amount":13062.48,"10th_percentile":6127.66,"90th_percentile":13611.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":13828.13,"10th_percentile":13828.13,"90th_percentile":13828.13,"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 Healthcare","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":44.43,"10th_percentile":44.43,"90th_percentile":44.43,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"30","median_amount":15565.5,"10th_percentile":7920.86,"90th_percentile":17722.05,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"1 through 10","median_amount":14931.64,"10th_percentile":14218.5,"90th_percentile":16175.0,"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":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":8047.14,"10th_percentile":8047.14,"90th_percentile":8047.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Breast/Lymphatic Surgery and Related Procedures","code_information":[{"code":"5093","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"18","median_amount":15959.95,"10th_percentile":12613.24,"90th_percentile":26652.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":11398.86,"10th_percentile":11398.86,"90th_percentile":11398.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":9786.46,"10th_percentile":9775.76,"90th_percentile":9787.23,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"1 through 10","median_amount":35750.18,"10th_percentile":25249.54,"90th_percentile":59494.35,"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":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"19","median_amount":25862.28,"10th_percentile":22736.12,"90th_percentile":42584.18},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":6204.6,"10th_percentile":6204.6,"90th_percentile":6204.6,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"77","median_amount":29223.76,"10th_percentile":21354.35,"90th_percentile":42051.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"13","median_amount":8152.06,"10th_percentile":6418.66,"90th_percentile":12492.74},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":6204.61,"10th_percentile":6204.61,"90th_percentile":6204.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":9783.47,"10th_percentile":9628.47,"90th_percentile":9826.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":5883.05,"10th_percentile":5883.05,"90th_percentile":6127.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","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":4245.29,"10th_percentile":4245.29,"90th_percentile":4245.29,"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":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"13","median_amount":17090.73,"10th_percentile":12484.14,"90th_percentile":23548.25,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":9782.98,"10th_percentile":9775.48,"90th_percentile":9790.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Breast/Lymphatic Surgery and Related Procedures","code_information":[{"code":"5094","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"1 through 10","median_amount":28868.22,"10th_percentile":28868.22,"90th_percentile":29018.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":17773.66,"10th_percentile":17773.66,"90th_percentile":17773.66,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"1 through 10","median_amount":64254.65,"10th_percentile":64254.65,"90th_percentile":64254.65,"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":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"1 through 10","median_amount":44394.27,"10th_percentile":25248.69,"90th_percentile":65139.69},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":8708.32,"10th_percentile":8708.32,"90th_percentile":8708.32,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"1 through 10","median_amount":47614.55,"10th_percentile":23763.94,"90th_percentile":62591.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":36016.03,"10th_percentile":36016.03,"90th_percentile":36016.03},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","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":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"1 through 10","median_amount":19677.0,"10th_percentile":19677.0,"90th_percentile":22345.9,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Strapping and Cast Application","code_information":[{"code":"5101","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"36","median_amount":1851.65,"10th_percentile":464.75,"90th_percentile":3030.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1185.51,"10th_percentile":225.81,"90th_percentile":2225.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"115","median_amount":686.65,"10th_percentile":297.59,"90th_percentile":1203.05,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1363.38,"10th_percentile":1165.72,"90th_percentile":1892.07,"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":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"26","median_amount":2629.0,"10th_percentile":874.0,"90th_percentile":6834.0,"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":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"20","median_amount":150.0,"10th_percentile":75.0,"90th_percentile":348.05},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":632.7,"10th_percentile":140.0,"90th_percentile":1878.87,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"21","median_amount":493.53,"10th_percentile":59.53,"90th_percentile":1295.7,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"11","median_amount":292.26,"10th_percentile":125.71,"90th_percentile":1297.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"111","median_amount":2136.0,"10th_percentile":317.0,"90th_percentile":4652.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"13","median_amount":590.8,"10th_percentile":408.8,"90th_percentile":2532.6},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1275.59,"10th_percentile":1275.59,"90th_percentile":1275.59,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":750.08,"10th_percentile":750.08,"90th_percentile":750.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":424.67,"10th_percentile":183.46,"90th_percentile":2847.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":145.07,"10th_percentile":145.07,"90th_percentile":145.07,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"102","median_amount":763.95,"10th_percentile":158.0,"90th_percentile":1681.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1272.0,"10th_percentile":705.12,"90th_percentile":2377.61,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"60","median_amount":1156.16,"10th_percentile":269.44,"90th_percentile":3139.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":285.36,"10th_percentile":285.36,"90th_percentile":285.36,"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 Healthcare","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":1727.45,"10th_percentile":979.91,"90th_percentile":2315.69,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"11","median_amount":981.0,"10th_percentile":384.59,"90th_percentile":1962.0,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"1 through 10","median_amount":2376.0,"10th_percentile":1336.2,"90th_percentile":3146.0,"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":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"113","median_amount":582.34,"10th_percentile":158.0,"90th_percentile":1387.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Strapping and Cast Application","code_information":[{"code":"5102","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":108.97,"10th_percentile":108.97,"90th_percentile":108.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":225.81,"10th_percentile":225.81,"90th_percentile":225.81,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"11","median_amount":234.73,"10th_percentile":79.43,"90th_percentile":525.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"1 through 10","median_amount":272.42,"10th_percentile":272.42,"90th_percentile":272.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":333.72,"10th_percentile":333.72,"90th_percentile":410.27,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":71.96,"10th_percentile":70.52,"90th_percentile":440.17,"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 Healthcare","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":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Musculoskeletal Procedures","code_information":[{"code":"5111","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"1 through 10","median_amount":4173.42,"10th_percentile":893.96,"90th_percentile":15024.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":530.43,"10th_percentile":285.27,"90th_percentile":1092.15,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"1 through 10","median_amount":10669.35,"10th_percentile":10027.96,"90th_percentile":23511.58,"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":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"1 through 10","median_amount":3003.0,"10th_percentile":1882.0,"90th_percentile":21067.84},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":577.61,"10th_percentile":577.61,"90th_percentile":699.35,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"39","median_amount":11464.58,"10th_percentile":1542.27,"90th_percentile":28263.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":4169.22,"10th_percentile":4169.22,"90th_percentile":4169.22},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":892.04,"10th_percentile":892.04,"90th_percentile":929.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":245.06,"10th_percentile":245.06,"90th_percentile":250.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1026.35,"10th_percentile":929.14,"90th_percentile":4186.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":623.74,"10th_percentile":623.74,"90th_percentile":623.74,"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":"Molina Healthcare","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":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"1 through 10","median_amount":432.0,"10th_percentile":412.0,"90th_percentile":19612.57,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"1 through 10","median_amount":393.0,"10th_percentile":393.0,"90th_percentile":393.0,"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":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":250.06,"10th_percentile":245.06,"90th_percentile":530.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Musculoskeletal Procedures","code_information":[{"code":"5112","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"55","median_amount":4157.2,"10th_percentile":2451.33,"90th_percentile":9691.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2609.43,"10th_percentile":1572.92,"90th_percentile":2686.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"35","median_amount":1638.52,"10th_percentile":1319.57,"90th_percentile":1642.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"29","median_amount":14081.5,"10th_percentile":7372.06,"90th_percentile":29253.98,"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":"BCBS","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"67","median_amount":10906.57,"10th_percentile":5655.4,"90th_percentile":17604.05},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":1638.32,"10th_percentile":924.54,"90th_percentile":2686.13,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"12","median_amount":1641.93,"10th_percentile":1634.93,"90th_percentile":7399.5,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1520.49,"10th_percentile":1520.49,"90th_percentile":1551.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"173","median_amount":10402.25,"10th_percentile":6644.53,"90th_percentile":20035.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"30","median_amount":3449.13,"10th_percentile":2260.08,"90th_percentile":11654.31},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1494.19,"10th_percentile":1494.19,"90th_percentile":1637.43,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"12","median_amount":1638.32,"10th_percentile":577.61,"90th_percentile":2701.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1476.94,"10th_percentile":1476.94,"90th_percentile":1476.94,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"33","median_amount":1634.93,"10th_percentile":1467.57,"90th_percentile":1637.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1962.65,"10th_percentile":1962.65,"90th_percentile":1962.65,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"44","median_amount":1638.32,"10th_percentile":648.13,"90th_percentile":2701.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1638.32,"10th_percentile":1638.32,"90th_percentile":1641.61,"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":"Molina Healthcare","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":1671.09,"10th_percentile":1671.09,"90th_percentile":1671.09,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"39","median_amount":2664.0,"10th_percentile":1475.56,"90th_percentile":8566.0,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"1 through 10","median_amount":2631.5,"10th_percentile":2435.0,"90th_percentile":8817.51,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"40","median_amount":1634.94,"10th_percentile":1247.84,"90th_percentile":1642.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":577.61,"10th_percentile":577.61,"90th_percentile":577.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 3 Musculoskeletal Procedures","code_information":[{"code":"5113","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"80","median_amount":6180.0,"10th_percentile":4929.65,"90th_percentile":10522.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"19","median_amount":2812.77,"10th_percentile":2578.9,"90th_percentile":6624.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"29","median_amount":3314.6,"10th_percentile":2947.7,"90th_percentile":3323.7,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2683.79,"10th_percentile":2683.79,"90th_percentile":2683.79,"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":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"87","median_amount":21391.42,"10th_percentile":11450.76,"90th_percentile":28214.7,"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":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"149","median_amount":22089.85,"10th_percentile":14323.15,"90th_percentile":34783.86},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":4080.48,"10th_percentile":2578.9,"90th_percentile":6665.99,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3320.6,"10th_percentile":3314.6,"90th_percentile":3320.6,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3082.58,"10th_percentile":3082.58,"90th_percentile":3082.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"352","median_amount":21915.53,"10th_percentile":14030.23,"90th_percentile":30009.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"56","median_amount":7322.44,"10th_percentile":5403.75,"90th_percentile":10047.93},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3321.1,"10th_percentile":3314.6,"90th_percentile":3321.1,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"25","median_amount":5327.13,"10th_percentile":2578.9,"90th_percentile":6843.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"29","median_amount":3314.6,"10th_percentile":2922.6,"90th_percentile":3322.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3798.34,"10th_percentile":3798.34,"90th_percentile":6575.0,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"66","median_amount":2978.99,"10th_percentile":2133.59,"90th_percentile":6774.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 Healthcare","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":2739.85,"10th_percentile":2737.47,"90th_percentile":6756.92,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"84","median_amount":8529.54,"10th_percentile":4904.26,"90th_percentile":12849.0,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"1 through 10","median_amount":7826.0,"10th_percentile":7327.62,"90th_percentile":11336.8,"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":"[APC ($): FEE SCHEDULE]","count":"17","median_amount":3314.61,"10th_percentile":3290.11,"90th_percentile":3322.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2578.9,"10th_percentile":2578.9,"90th_percentile":2578.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 4 Musculoskeletal Procedures","code_information":[{"code":"5114","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"124","median_amount":10815.17,"10th_percentile":6180.0,"90th_percentile":18384.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"34","median_amount":6624.43,"10th_percentile":5892.56,"90th_percentile":9809.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"68","median_amount":7297.83,"10th_percentile":6727.01,"90th_percentile":7336.0,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"117","median_amount":31448.68,"10th_percentile":21885.4,"90th_percentile":45069.67,"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":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"182","median_amount":32435.95,"10th_percentile":23973.94,"90th_percentile":49063.84},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":"31","median_amount":6624.43,"10th_percentile":5892.56,"90th_percentile":8769.15,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"15","median_amount":7297.83,"10th_percentile":6902.73,"90th_percentile":7305.33,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6786.99,"10th_percentile":6786.99,"90th_percentile":6786.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"522","median_amount":31878.57,"10th_percentile":23535.7,"90th_percentile":48349.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"57","median_amount":10132.48,"10th_percentile":8649.62,"90th_percentile":14856.59},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7447.3,"10th_percentile":6980.86,"90th_percentile":7448.6,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"26","median_amount":6624.43,"10th_percentile":5659.8,"90th_percentile":9685.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6573.05,"10th_percentile":6564.75,"90th_percentile":6574.55,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"57","median_amount":7297.83,"10th_percentile":6906.32,"90th_percentile":7405.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6616.12,"10th_percentile":6616.12,"90th_percentile":14362.14,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"66","median_amount":6624.43,"10th_percentile":5892.56,"90th_percentile":9205.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":8538.88,"10th_percentile":8538.88,"90th_percentile":8538.88,"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 Healthcare","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":6756.92,"10th_percentile":6487.18,"90th_percentile":7140.95,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"138","median_amount":13046.0,"10th_percentile":8518.81,"90th_percentile":18477.71,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"18","median_amount":11987.03,"10th_percentile":9927.46,"90th_percentile":19025.25,"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":"[APC ($): FEE SCHEDULE]","count":"45","median_amount":7297.84,"10th_percentile":6723.7,"90th_percentile":7305.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 5 Musculoskeletal Procedures","code_information":[{"code":"5115","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"52","median_amount":15048.2,"10th_percentile":13361.85,"90th_percentile":25870.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"15","median_amount":15045.08,"10th_percentile":13576.52,"90th_percentile":15788.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"91","median_amount":13220.27,"10th_percentile":13055.88,"90th_percentile":13587.77,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"82","median_amount":60944.8,"10th_percentile":47633.95,"90th_percentile":73310.0,"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":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"97","median_amount":58078.75,"10th_percentile":49906.49,"90th_percentile":76325.09},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":14900.12,"10th_percentile":6212.03,"90th_percentile":15446.23,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"19","median_amount":13469.77,"10th_percentile":13151.88,"90th_percentile":13724.18,"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":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":12583.67,"10th_percentile":12224.27,"90th_percentile":14088.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"273","median_amount":56422.7,"10th_percentile":44785.21,"90th_percentile":69082.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"24","median_amount":18690.53,"10th_percentile":15635.19,"90th_percentile":21518.07},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"24","median_amount":15248.04,"10th_percentile":8088.16,"90th_percentile":17707.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":11829.94,"10th_percentile":11829.94,"90th_percentile":11829.94,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"71","median_amount":13327.12,"10th_percentile":12577.36,"90th_percentile":13729.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":14121.72,"10th_percentile":14121.72,"90th_percentile":14124.09,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"23","median_amount":14948.76,"10th_percentile":14429.5,"90th_percentile":21113.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":13649.49,"10th_percentile":13649.49,"90th_percentile":13649.49,"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 Healthcare","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":14729.75,"10th_percentile":10739.68,"90th_percentile":17618.03,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"79","median_amount":26045.14,"10th_percentile":13717.64,"90th_percentile":27848.0,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"1 through 10","median_amount":19282.39,"10th_percentile":19282.39,"90th_percentile":24778.29,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"73","median_amount":13165.08,"10th_percentile":12914.08,"90th_percentile":13593.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 6 Musculoskeletal Procedures","code_information":[{"code":"5116","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"14","median_amount":28173.1,"10th_percentile":19779.67,"90th_percentile":30672.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":15277.59,"10th_percentile":15277.59,"90th_percentile":15277.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"11","median_amount":18786.76,"10th_percentile":118.32,"90th_percentile":18982.11,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"20","median_amount":85594.16,"10th_percentile":47361.36,"90th_percentile":151987.65,"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":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"11","median_amount":72024.98,"10th_percentile":44832.35,"90th_percentile":121577.47},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":21185.77,"10th_percentile":17099.35,"90th_percentile":28775.86,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":18888.09,"10th_percentile":18888.09,"90th_percentile":18888.09,"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":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"67","median_amount":84619.42,"10th_percentile":47086.81,"90th_percentile":138067.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":12177.51,"10th_percentile":10896.55,"90th_percentile":26539.53},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":19372.76,"10th_percentile":19372.76,"90th_percentile":19372.76,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":20902.51,"10th_percentile":20902.51,"90th_percentile":20902.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":17072.92,"10th_percentile":17072.92,"90th_percentile":17072.92,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"14","median_amount":18940.0,"10th_percentile":18394.76,"90th_percentile":19154.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":23635.25,"10th_percentile":23635.25,"90th_percentile":23635.25,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":21418.03,"10th_percentile":21418.03,"90th_percentile":23528.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","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":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"15","median_amount":17437.6,"10th_percentile":11429.78,"90th_percentile":36006.75,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"1 through 10","median_amount":11916.0,"10th_percentile":11916.0,"90th_percentile":11916.0,"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":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":18791.46,"10th_percentile":18444.26,"90th_percentile":18978.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Airway Endoscopy","code_information":[{"code":"5151","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"1 through 10","median_amount":994.4,"10th_percentile":994.4,"90th_percentile":994.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":200.36,"10th_percentile":200.36,"90th_percentile":331.33,"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":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":741.27,"10th_percentile":741.27,"90th_percentile":741.27,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":199.14,"10th_percentile":199.14,"90th_percentile":199.14,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"63","median_amount":192.91,"10th_percentile":184.45,"90th_percentile":306.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"1 through 10","median_amount":200.37,"10th_percentile":200.37,"90th_percentile":200.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":69.02,"10th_percentile":69.02,"90th_percentile":69.02},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"34","median_amount":198.0,"10th_percentile":198.0,"90th_percentile":330.0,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":199.14,"10th_percentile":199.14,"90th_percentile":199.14,"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":"Molina Healthcare","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":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"1 through 10","median_amount":116.17,"10th_percentile":116.17,"90th_percentile":116.17,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Airway Endoscopy","code_information":[{"code":"5153","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"1 through 10","median_amount":9450.1,"10th_percentile":4038.0,"90th_percentile":9691.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1765.67,"10th_percentile":1761.67,"90th_percentile":1769.4,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"1 through 10","median_amount":13737.85,"10th_percentile":13737.85,"90th_percentile":14311.02,"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":"BCBS","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"18","median_amount":13681.92,"10th_percentile":10086.13,"90th_percentile":25216.84},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":212.74,"10th_percentile":212.74,"90th_percentile":2629.64,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1761.67,"10th_percentile":1761.67,"90th_percentile":1761.67,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"44","median_amount":13377.1,"10th_percentile":10112.87,"90th_percentile":19866.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":1428.2,"10th_percentile":1428.2,"90th_percentile":1428.2},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":215.81,"10th_percentile":215.81,"90th_percentile":215.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1365.5,"10th_percentile":1365.5,"90th_percentile":1365.5,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1764.67,"10th_percentile":1761.67,"90th_percentile":3629.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1733.48,"10th_percentile":1733.48,"90th_percentile":1733.48,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":212.0,"10th_percentile":212.0,"90th_percentile":218.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1768.86,"10th_percentile":1768.86,"90th_percentile":1768.86,"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 Healthcare","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":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"1 through 10","median_amount":432.0,"10th_percentile":432.0,"90th_percentile":2664.0,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1769.17,"10th_percentile":1769.17,"90th_percentile":1769.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Airway Endoscopy","code_information":[{"code":"5154","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"1 through 10","median_amount":10939.8,"10th_percentile":6149.36,"90th_percentile":29291.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":5032.95,"10th_percentile":2531.29,"90th_percentile":6957.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"13","median_amount":5886.81,"10th_percentile":3773.48,"90th_percentile":7079.94,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"1 through 10","median_amount":34011.35,"10th_percentile":21828.39,"90th_percentile":41416.99,"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":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"17","median_amount":36002.41,"10th_percentile":17898.98,"90th_percentile":53210.5},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":4402.3,"10th_percentile":2363.55,"90th_percentile":5814.78,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3772.48,"10th_percentile":3772.48,"90th_percentile":3773.48,"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":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6576.77,"10th_percentile":6576.77,"90th_percentile":6576.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"52","median_amount":32301.35,"10th_percentile":17509.52,"90th_percentile":50427.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":11009.92,"10th_percentile":10495.12,"90th_percentile":14317.57},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3827.82,"10th_percentile":3827.82,"90th_percentile":3827.82,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":4585.34,"10th_percentile":2363.55,"90th_percentile":4585.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6119.62,"10th_percentile":6119.62,"90th_percentile":6119.62,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"23","median_amount":3769.48,"10th_percentile":3754.48,"90th_percentile":7076.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5657.43,"10th_percentile":5657.43,"90th_percentile":6329.64,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"15","median_amount":4585.34,"10th_percentile":2363.55,"90th_percentile":5068.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","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":2295.57,"10th_percentile":2295.57,"90th_percentile":2295.57,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"1 through 10","median_amount":5891.0,"10th_percentile":3962.71,"90th_percentile":10309.85,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"1 through 10","median_amount":11124.75,"10th_percentile":11124.75,"90th_percentile":11124.75,"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":"[APC ($): FEE SCHEDULE]","count":"12","median_amount":6826.8,"10th_percentile":3528.75,"90th_percentile":7076.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 5 Airway Endoscopy","code_information":[{"code":"5155","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"16","median_amount":12989.0,"10th_percentile":10545.79,"90th_percentile":20995.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":9517.93,"10th_percentile":9517.93,"90th_percentile":11883.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7078.95,"10th_percentile":7078.95,"90th_percentile":7078.95,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"1 through 10","median_amount":36032.64,"10th_percentile":31342.09,"90th_percentile":47499.39,"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":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"16","median_amount":36966.98,"10th_percentile":27293.71,"90th_percentile":52627.69},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":8419.82,"10th_percentile":8272.12,"90th_percentile":12239.79,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7079.3,"10th_percentile":7079.3,"90th_percentile":7079.3,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"41","median_amount":35068.11,"10th_percentile":24565.67,"90th_percentile":48849.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":11228.64,"10th_percentile":7216.73,"90th_percentile":12639.48},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7041.73,"10th_percentile":7041.73,"90th_percentile":7041.73,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7071.8,"10th_percentile":6816.12,"90th_percentile":7079.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":5669.45,"10th_percentile":5514.75,"90th_percentile":8272.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","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":13957.57,"10th_percentile":13957.57,"90th_percentile":13957.57,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"1 through 10","median_amount":11458.76,"10th_percentile":8970.0,"90th_percentile":14990.5,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"1 through 10","median_amount":5891.0,"10th_percentile":5891.0,"90th_percentile":5891.0,"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":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7073.8,"10th_percentile":7073.8,"90th_percentile":7076.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 ENT Procedures","code_information":[{"code":"5161","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"1 through 10","median_amount":6410.77,"10th_percentile":6410.77,"90th_percentile":6410.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":238.2,"10th_percentile":238.2,"90th_percentile":238.2,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"1 through 10","median_amount":18080.52,"10th_percentile":18080.52,"90th_percentile":38206.92,"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":"BCBS","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"1 through 10","median_amount":23918.08,"10th_percentile":23918.08,"90th_percentile":23918.08},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":1459.6,"10th_percentile":1459.6,"90th_percentile":1459.6,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"18","median_amount":18292.29,"10th_percentile":8800.38,"90th_percentile":39030.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":13178.16,"10th_percentile":13178.16,"90th_percentile":13178.16},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":198.58,"10th_percentile":198.58,"90th_percentile":198.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":242.07,"10th_percentile":242.07,"90th_percentile":242.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":54.59,"10th_percentile":54.59,"90th_percentile":54.59,"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":"Molina Healthcare","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":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"1 through 10","median_amount":432.0,"10th_percentile":432.0,"90th_percentile":432.0,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1031.56,"10th_percentile":1031.56,"90th_percentile":1031.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 ENT Procedures","code_information":[{"code":"5162","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"1 through 10","median_amount":13882.23,"10th_percentile":13882.23,"90th_percentile":13882.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":7505.62,"10th_percentile":7505.62,"90th_percentile":7505.62},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1021.52,"10th_percentile":1021.52,"90th_percentile":1021.52,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","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":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 ENT Procedures","code_information":[{"code":"5163","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"21","median_amount":9270.0,"10th_percentile":8199.4,"90th_percentile":9270.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2634.82,"10th_percentile":2634.82,"90th_percentile":3259.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"1 through 10","median_amount":12719.87,"10th_percentile":10691.17,"90th_percentile":13800.05,"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":"BCBS","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"36","median_amount":13024.97,"10th_percentile":11833.94,"90th_percentile":13887.12},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":2634.82,"10th_percentile":2634.82,"90th_percentile":2634.82,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"104","median_amount":12817.51,"10th_percentile":11043.09,"90th_percentile":13700.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"12","median_amount":4501.65,"10th_percentile":4291.59,"90th_percentile":4823.02},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2191.37,"10th_percentile":2191.37,"90th_percentile":2634.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2634.82,"10th_percentile":2559.58,"90th_percentile":7799.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","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":2687.52,"10th_percentile":2687.52,"90th_percentile":2687.52,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"23","median_amount":3996.0,"10th_percentile":2131.2,"90th_percentile":3996.0,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"1 through 10","median_amount":3652.5,"10th_percentile":314.36,"90th_percentile":3652.5,"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":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 ENT Procedures","code_information":[{"code":"5164","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"51","median_amount":6180.0,"10th_percentile":4231.24,"90th_percentile":9894.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"12","median_amount":2497.92,"10th_percentile":2492.42,"90th_percentile":4784.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3313.03,"10th_percentile":2594.1,"90th_percentile":3326.55,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"31","median_amount":16342.3,"10th_percentile":11650.76,"90th_percentile":23913.27,"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":"BCBS","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"97","median_amount":16179.56,"10th_percentile":13330.37,"90th_percentile":22712.09},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":3809.83,"10th_percentile":2421.25,"90th_percentile":4924.69,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2945.53,"10th_percentile":2945.53,"90th_percentile":2945.53,"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":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"254","median_amount":16405.53,"10th_percentile":12734.55,"90th_percentile":22809.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"28","median_amount":5021.25,"10th_percentile":3749.56,"90th_percentile":6569.34},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"15","median_amount":2492.42,"10th_percentile":2191.37,"90th_percentile":4924.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3199.03,"10th_percentile":2921.03,"90th_percentile":3321.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3260.02,"10th_percentile":3260.02,"90th_percentile":3260.02,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"41","median_amount":2492.42,"10th_percentile":2392.93,"90th_percentile":4728.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","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":2542.27,"10th_percentile":2469.68,"90th_percentile":2542.27,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"47","median_amount":5892.68,"10th_percentile":4565.0,"90th_percentile":10309.25,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"1 through 10","median_amount":8258.13,"10th_percentile":5380.0,"90th_percentile":9416.5,"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":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3033.83,"10th_percentile":3033.83,"90th_percentile":3033.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 5 ENT Procedures","code_information":[{"code":"5165","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"45","median_amount":9619.9,"10th_percentile":6180.0,"90th_percentile":21021.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"12","median_amount":3054.75,"10th_percentile":2492.42,"90th_percentile":5423.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"14","median_amount":6050.27,"10th_percentile":5675.77,"90th_percentile":6055.63,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"33","median_amount":33796.07,"10th_percentile":14883.31,"90th_percentile":55767.71,"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":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"95","median_amount":20754.6,"10th_percentile":15764.89,"90th_percentile":51858.11},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":5070.43,"10th_percentile":2492.42,"90th_percentile":6870.63,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6049.27,"10th_percentile":6049.27,"90th_percentile":6049.27,"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":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5620.24,"10th_percentile":5620.24,"90th_percentile":5620.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"217","median_amount":20340.11,"10th_percentile":14553.9,"90th_percentile":54034.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"21","median_amount":5755.92,"10th_percentile":4930.52,"90th_percentile":16381.17},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"16","median_amount":5264.41,"10th_percentile":2421.25,"90th_percentile":5800.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5465.87,"10th_percentile":5465.87,"90th_percentile":5465.87,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"16","median_amount":6046.27,"10th_percentile":5896.27,"90th_percentile":6436.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5732.8,"10th_percentile":5732.8,"90th_percentile":5732.8,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"49","median_amount":2492.42,"10th_percentile":2492.42,"90th_percentile":5800.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5514.75,"10th_percentile":5514.75,"90th_percentile":5514.75,"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 Healthcare","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":2469.68,"10th_percentile":2440.79,"90th_percentile":2542.27,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"55","median_amount":8941.57,"10th_percentile":4885.6,"90th_percentile":14751.52,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"1 through 10","median_amount":9479.0,"10th_percentile":4731.82,"90th_percentile":13213.16,"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":"[APC ($): FEE SCHEDULE]","count":"11","median_amount":6043.67,"10th_percentile":5656.17,"90th_percentile":6049.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2492.42,"10th_percentile":2492.42,"90th_percentile":2492.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Cochlear Implant Procedure","code_information":[{"code":"5166","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":29874.08,"10th_percentile":29874.08,"90th_percentile":29874.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":32502.85,"10th_percentile":32498.97,"90th_percentile":32505.16,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"1 through 10","median_amount":151246.31,"10th_percentile":151246.31,"90th_percentile":156499.79},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":26886.67,"10th_percentile":26886.67,"90th_percentile":26886.67,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"1 through 10","median_amount":196233.9,"10th_percentile":196233.9,"90th_percentile":196233.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":32175.47,"10th_percentile":32175.47,"90th_percentile":32175.47,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":32501.97,"10th_percentile":32501.97,"90th_percentile":32501.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":44811.12,"10th_percentile":44811.12,"90th_percentile":44811.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","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":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":32126.47,"10th_percentile":32126.47,"90th_percentile":32493.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Vascular Procedures","code_information":[{"code":"5181","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"1 through 10","median_amount":3338.0,"10th_percentile":2535.0,"90th_percentile":33767.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":925.62,"10th_percentile":925.62,"90th_percentile":1251.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"47","median_amount":631.6,"10th_percentile":631.6,"90th_percentile":947.4,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"1 through 10","median_amount":6853.12,"10th_percentile":3062.26,"90th_percentile":31629.36,"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":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"13","median_amount":3045.8,"10th_percentile":2535.0,"90th_percentile":4050.47},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":925.62,"10th_percentile":925.62,"90th_percentile":925.62,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":631.6,"10th_percentile":264.1,"90th_percentile":2511.1,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":587.39,"10th_percentile":587.39,"90th_percentile":587.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"84","median_amount":3668.12,"10th_percentile":3018.58,"90th_percentile":8788.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":1056.5,"10th_percentile":649.03,"90th_percentile":1071.79},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":647.73,"10th_percentile":647.73,"90th_percentile":647.73,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":925.62,"10th_percentile":925.62,"90th_percentile":2205.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"52","median_amount":631.6,"10th_percentile":484.6,"90th_percentile":947.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":698.26,"10th_percentile":698.26,"90th_percentile":698.26,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":925.62,"10th_percentile":899.19,"90th_percentile":1201.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":634.18,"10th_percentile":634.18,"90th_percentile":634.18,"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 Healthcare","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":906.44,"10th_percentile":906.44,"90th_percentile":906.44,"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":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"1 through 10","median_amount":1083.7,"10th_percentile":1083.7,"90th_percentile":1123.0,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"1 through 10","median_amount":1025.0,"10th_percentile":1025.0,"90th_percentile":1025.0,"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":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"38","median_amount":631.61,"10th_percentile":435.61,"90th_percentile":1492.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Vascular Procedures","code_information":[{"code":"5182","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"18","median_amount":2954.63,"10th_percentile":2415.12,"90th_percentile":6327.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"15","median_amount":978.69,"10th_percentile":925.62,"90th_percentile":1820.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"31","median_amount":1586.95,"10th_percentile":1487.48,"90th_percentile":1593.95,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"19","median_amount":5066.41,"10th_percentile":4573.08,"90th_percentile":24633.47,"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":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"31","median_amount":5066.41,"10th_percentile":3253.38,"90th_percentile":5965.13},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":925.62,"10th_percentile":888.67,"90th_percentile":7758.45,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1592.95,"10th_percentile":1586.95,"90th_percentile":1601.02,"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":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2990.32,"10th_percentile":2990.32,"90th_percentile":2990.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"91","median_amount":5023.47,"10th_percentile":4325.03,"90th_percentile":15766.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"12","median_amount":1631.35,"10th_percentile":1482.6,"90th_percentile":4453.8},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1593.45,"10th_percentile":1593.45,"90th_percentile":1593.45,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"11","median_amount":1377.88,"10th_percentile":925.62,"90th_percentile":8100.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"40","median_amount":1586.95,"10th_percentile":1439.95,"90th_percentile":1594.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1377.88,"10th_percentile":925.62,"90th_percentile":7758.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1377.88,"10th_percentile":1377.88,"90th_percentile":1377.88,"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 Healthcare","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":917.17,"10th_percentile":917.17,"90th_percentile":917.17,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"25","median_amount":2664.0,"10th_percentile":1645.73,"90th_percentile":2664.0,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"1 through 10","median_amount":3652.5,"10th_percentile":3652.5,"90th_percentile":3652.5,"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":"[APC ($): FEE SCHEDULE]","count":"25","median_amount":1586.96,"10th_percentile":1269.57,"90th_percentile":2094.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Vascular Procedures","code_information":[{"code":"5183","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"64","median_amount":5249.63,"10th_percentile":3171.33,"90th_percentile":7288.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"26","median_amount":2660.97,"10th_percentile":2554.75,"90th_percentile":4786.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"63","median_amount":3215.4,"10th_percentile":2951.45,"90th_percentile":3225.24,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2608.47,"10th_percentile":2608.47,"90th_percentile":2608.47,"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":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"49","median_amount":15669.6,"10th_percentile":3697.0,"90th_percentile":28601.44,"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":"BCBS","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"52","median_amount":15704.35,"10th_percentile":9990.65,"90th_percentile":21938.88},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":"19","median_amount":2660.97,"10th_percentile":2554.75,"90th_percentile":4418.51,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3218.02,"10th_percentile":3215.4,"90th_percentile":6045.59,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2990.32,"10th_percentile":2990.32,"90th_percentile":5543.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"268","median_amount":14950.11,"10th_percentile":3644.0,"90th_percentile":21959.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"31","median_amount":5399.82,"10th_percentile":2550.8,"90th_percentile":8808.35},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"11","median_amount":3215.4,"10th_percentile":3108.21,"90th_percentile":3255.21,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"14","median_amount":2660.97,"10th_percentile":2554.75,"90th_percentile":4242.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2806.13,"10th_percentile":2806.13,"90th_percentile":2806.13,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"101","median_amount":3215.4,"10th_percentile":2985.56,"90th_percentile":3223.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3674.9,"10th_percentile":3674.9,"90th_percentile":4443.88,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3206.33,"10th_percentile":3206.33,"90th_percentile":3206.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"26","median_amount":2660.97,"10th_percentile":2525.31,"90th_percentile":4242.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2660.97,"10th_percentile":2660.97,"90th_percentile":2660.97,"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":"Molina Healthcare","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":3135.53,"10th_percentile":3135.53,"90th_percentile":5453.81,"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":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"75","median_amount":8325.71,"10th_percentile":3644.0,"90th_percentile":8566.0,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"1 through 10","median_amount":7826.0,"10th_percentile":7288.0,"90th_percentile":7826.0,"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":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"50","median_amount":3215.4,"10th_percentile":2727.31,"90th_percentile":3228.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Vascular Procedures","code_information":[{"code":"5184","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"12","median_amount":13886.89,"10th_percentile":7955.87,"90th_percentile":22939.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":5529.92,"10th_percentile":4800.25,"90th_percentile":8088.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5522.31,"10th_percentile":5183.16,"90th_percentile":9473.53,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"1 through 10","median_amount":54831.43,"10th_percentile":26558.48,"90th_percentile":75521.51,"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":"BCBS","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"13","median_amount":26296.97,"10th_percentile":18242.47,"90th_percentile":56259.79},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":6752.4,"10th_percentile":6752.4,"90th_percentile":8328.9,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5526.16,"10th_percentile":5526.16,"90th_percentile":8407.84,"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":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5139.33,"10th_percentile":5139.33,"90th_percentile":5139.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"37","median_amount":44781.27,"10th_percentile":24499.15,"90th_percentile":74613.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":23068.63,"10th_percentile":23068.63,"90th_percentile":26362.26},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4803.08,"10th_percentile":4803.08,"90th_percentile":4803.08,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":7998.74,"10th_percentile":7993.46,"90th_percentile":11106.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"19","median_amount":5525.31,"10th_percentile":5228.31,"90th_percentile":8156.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7811.4,"10th_percentile":7811.4,"90th_percentile":7811.4,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":7996.4,"10th_percentile":6752.4,"90th_percentile":8347.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","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":343.98,"10th_percentile":343.98,"90th_percentile":343.98,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"1 through 10","median_amount":19977.5,"10th_percentile":13046.0,"90th_percentile":22830.5,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"1 through 10","median_amount":16277.74,"10th_percentile":16277.74,"90th_percentile":16277.74,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"14","median_amount":5522.31,"10th_percentile":4617.21,"90th_percentile":8573.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Endovascular Procedures","code_information":[{"code":"5191","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"22","median_amount":17992.18,"10th_percentile":9787.13,"90th_percentile":22844.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":3029.45,"10th_percentile":2942.95,"90th_percentile":3749.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"72","median_amount":3292.9,"10th_percentile":3285.79,"90th_percentile":5831.51,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"16","median_amount":25065.07,"10th_percentile":21258.71,"90th_percentile":42487.78,"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":"BCBS","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"42","median_amount":26924.94,"10th_percentile":20512.95,"90th_percentile":38270.17},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":3029.45,"10th_percentile":3029.45,"90th_percentile":4704.92,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"19","median_amount":3287.79,"10th_percentile":3187.79,"90th_percentile":6591.42,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3055.79,"10th_percentile":3055.79,"90th_percentile":3055.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"150","median_amount":26308.28,"10th_percentile":19154.03,"90th_percentile":38516.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":8351.5,"10th_percentile":5571.69,"90th_percentile":16480.42},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3180.01,"10th_percentile":3180.01,"90th_percentile":3285.79,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":3029.45,"10th_percentile":2908.52,"90th_percentile":6528.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2964.03,"10th_percentile":2964.03,"90th_percentile":2964.03,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"83","median_amount":3288.79,"10th_percentile":3138.79,"90th_percentile":3301.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3839.12,"10th_percentile":3233.23,"90th_percentile":6494.01,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"26","median_amount":3029.45,"10th_percentile":2908.52,"90th_percentile":4448.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3029.45,"10th_percentile":2908.52,"90th_percentile":3299.2,"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 Healthcare","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":3090.04,"10th_percentile":3090.04,"90th_percentile":4782.56,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"31","median_amount":9928.15,"10th_percentile":8181.6,"90th_percentile":10377.0,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"1 through 10","median_amount":7583.2,"10th_percentile":5528.07,"90th_percentile":9479.0,"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":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"65","median_amount":3285.8,"10th_percentile":2977.16,"90th_percentile":3298.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Endovascular Procedures","code_information":[{"code":"5192","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"1 through 10","median_amount":9509.41,"10th_percentile":9509.41,"90th_percentile":9921.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":4626.65,"10th_percentile":4626.65,"90th_percentile":4626.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"15","median_amount":5824.51,"10th_percentile":5481.51,"90th_percentile":5824.51,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4659.61,"10th_percentile":4659.61,"90th_percentile":5848.29,"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":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"1 through 10","median_amount":21915.35,"10th_percentile":21482.19,"90th_percentile":25115.68,"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":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"1 through 10","median_amount":19201.56,"10th_percentile":11640.64,"90th_percentile":24234.17},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":7613.99,"10th_percentile":4163.98,"90th_percentile":8787.08,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5824.51,"10th_percentile":5824.51,"90th_percentile":11132.43,"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":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5416.79,"10th_percentile":5416.79,"90th_percentile":5443.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"16","median_amount":20923.68,"10th_percentile":5848.29,"90th_percentile":42122.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":8328.85,"10th_percentile":6449.77,"90th_percentile":8677.2},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"47","median_amount":5824.51,"10th_percentile":5677.51,"90th_percentile":5832.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5731.32,"10th_percentile":5731.32,"90th_percentile":7634.31,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":4626.65,"10th_percentile":4441.95,"90th_percentile":7448.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4659.61,"10th_percentile":4659.61,"90th_percentile":5848.29,"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":"Molina Healthcare","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":4719.18,"10th_percentile":4719.18,"90th_percentile":4719.18,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"1 through 10","median_amount":28278.5,"10th_percentile":28278.5,"90th_percentile":28278.5,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"33","median_amount":5824.52,"10th_percentile":4659.61,"90th_percentile":5824.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Endovascular Procedures","code_information":[{"code":"5193","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"19","median_amount":27206.02,"10th_percentile":9770.5,"90th_percentile":53014.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"12","median_amount":14854.14,"10th_percentile":13456.22,"90th_percentile":23742.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"38","median_amount":11592.71,"10th_percentile":11462.71,"90th_percentile":18103.22,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"14","median_amount":71856.2,"10th_percentile":52075.4,"90th_percentile":139180.4,"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":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"36","median_amount":69228.05,"10th_percentile":44290.94,"90th_percentile":125610.62},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":13724.26,"10th_percentile":11932.19,"90th_percentile":20734.91,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"12","median_amount":11585.21,"10th_percentile":10528.11,"90th_percentile":11592.71,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":10774.25,"10th_percentile":10774.25,"90th_percentile":10774.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"92","median_amount":79045.32,"10th_percentile":41855.47,"90th_percentile":126226.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"13","median_amount":21536.87,"10th_percentile":14206.64,"90th_percentile":29836.61},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":11581.71,"10th_percentile":11581.71,"90th_percentile":11581.71,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":11524.9,"10th_percentile":3634.3,"90th_percentile":20051.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":10233.19,"10th_percentile":10233.19,"90th_percentile":10233.19,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"72","median_amount":11588.21,"10th_percentile":11438.21,"90th_percentile":16991.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"19","median_amount":5820.02,"10th_percentile":1593.71,"90th_percentile":17819.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":11632.49,"10th_percentile":11632.49,"90th_percentile":11632.49,"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 Healthcare","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":18008.48,"10th_percentile":18008.48,"90th_percentile":18008.48,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"24","median_amount":35793.5,"10th_percentile":27664.0,"90th_percentile":42713.66,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"1 through 10","median_amount":43468.7,"10th_percentile":43468.7,"90th_percentile":43468.7,"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":"[APC ($): FEE SCHEDULE]","count":"42","median_amount":11593.11,"10th_percentile":11198.11,"90th_percentile":15184.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Endovascular Procedures","code_information":[{"code":"5194","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"1 through 10","median_amount":38408.2,"10th_percentile":19373.57,"90th_percentile":89553.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":24697.11,"10th_percentile":24697.11,"90th_percentile":24697.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":11606.06,"10th_percentile":11606.06,"90th_percentile":11606.06,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"1 through 10","median_amount":55263.43,"10th_percentile":55263.43,"90th_percentile":55263.43,"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":"BCBS","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"15","median_amount":60696.16,"10th_percentile":54417.27,"90th_percentile":132033.1},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":13432.73,"10th_percentile":13432.73,"90th_percentile":14800.81,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":18346.07,"10th_percentile":18346.07,"90th_percentile":18346.07,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":17059.99,"10th_percentile":17059.99,"90th_percentile":17059.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"33","median_amount":82690.1,"10th_percentile":55099.61,"90th_percentile":119790.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":16170.52,"10th_percentile":13558.24,"90th_percentile":25719.83},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4804.88,"10th_percentile":4804.88,"90th_percentile":4804.88,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"18","median_amount":18347.07,"10th_percentile":17952.07,"90th_percentile":20073.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":18050.57,"10th_percentile":18050.57,"90th_percentile":18050.57,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":7981.97,"10th_percentile":7981.97,"90th_percentile":13432.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":15269.44,"10th_percentile":15075.69,"90th_percentile":17906.15,"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":"Molina Healthcare","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":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"15","median_amount":30863.0,"10th_percentile":27141.74,"90th_percentile":46078.5,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"1 through 10","median_amount":26781.56,"10th_percentile":26781.56,"90th_percentile":26781.56,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"21","median_amount":18344.08,"10th_percentile":17956.98,"90th_percentile":18351.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Implantation Wireless PA Pressure Monitor","code_information":[{"code":"5200","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"1 through 10","median_amount":157020.97,"10th_percentile":157020.97,"90th_percentile":157020.97,"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":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":46977.33,"10th_percentile":46977.33,"90th_percentile":46977.33,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"1 through 10","median_amount":67153.7,"10th_percentile":67153.7,"90th_percentile":67153.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":29044.57,"10th_percentile":29044.57,"90th_percentile":29044.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":19144.14,"10th_percentile":19144.14,"90th_percentile":19144.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","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":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":29046.58,"10th_percentile":29046.58,"90th_percentile":29046.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Electrophysiologic Procedures","code_information":[{"code":"5212","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7751.79,"10th_percentile":7751.79,"90th_percentile":7751.79,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"1 through 10","median_amount":72928.85,"10th_percentile":72928.85,"90th_percentile":88223.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7751.79,"10th_percentile":7751.79,"90th_percentile":7751.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","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":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"1 through 10","median_amount":18145.38,"10th_percentile":18145.38,"90th_percentile":19064.0,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7026.12,"10th_percentile":7026.12,"90th_percentile":7026.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Electrophysiologic Procedures","code_information":[{"code":"5213","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"32","median_amount":38089.23,"10th_percentile":24992.22,"90th_percentile":62928.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":21947.71,"10th_percentile":21947.71,"90th_percentile":21947.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"71","median_amount":25061.5,"10th_percentile":24694.0,"90th_percentile":25073.69,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":23419.02,"10th_percentile":23419.02,"90th_percentile":23419.02,"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":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"30","median_amount":101208.58,"10th_percentile":82640.78,"90th_percentile":135693.9,"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":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"45","median_amount":96967.74,"10th_percentile":82192.87,"90th_percentile":134295.46},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"1 through 10","median_amount":88876.11,"10th_percentile":88876.11,"90th_percentile":88876.11,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":21071.56,"10th_percentile":20054.81,"90th_percentile":21947.71,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"15","median_amount":25062.5,"10th_percentile":24963.5,"90th_percentile":25063.5,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"163","median_amount":101733.92,"10th_percentile":82152.07,"90th_percentile":133874.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"22","median_amount":20226.4,"10th_percentile":18104.05,"90th_percentile":27578.11},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":24803.0,"10th_percentile":24743.0,"90th_percentile":25068.5,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"65","median_amount":25064.5,"10th_percentile":24669.5,"90th_percentile":25069.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":24660.51,"10th_percentile":24660.51,"90th_percentile":24660.51,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"11","median_amount":21947.71,"10th_percentile":21071.56,"90th_percentile":22774.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":21981.21,"10th_percentile":21981.21,"90th_percentile":22412.75,"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 Healthcare","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":22386.66,"10th_percentile":22386.66,"90th_percentile":22386.66,"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":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"45","median_amount":17146.0,"10th_percentile":13134.0,"90th_percentile":23171.52,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"1 through 10","median_amount":15661.0,"10th_percentile":15661.0,"90th_percentile":17369.82,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"58","median_amount":25062.01,"10th_percentile":22326.14,"90th_percentile":25069.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Pacemaker and Similar Procedures","code_information":[{"code":"5221","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"1 through 10","median_amount":15544.7,"10th_percentile":15544.7,"90th_percentile":15544.7},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","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":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Pacemaker and Similar Procedures","code_information":[{"code":"5222","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"1 through 10","median_amount":11975.97,"10th_percentile":11975.97,"90th_percentile":11975.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"20","median_amount":8461.51,"10th_percentile":8258.51,"90th_percentile":8473.74,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"1 through 10","median_amount":34197.29,"10th_percentile":34197.29,"90th_percentile":34197.29,"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":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"1 through 10","median_amount":34197.29,"10th_percentile":34193.14,"90th_percentile":34197.29},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":8456.51,"10th_percentile":8456.51,"90th_percentile":8456.51,"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":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"17","median_amount":34197.29,"10th_percentile":30117.43,"90th_percentile":34266.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":11848.6,"10th_percentile":11848.6,"90th_percentile":11848.6},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":8456.01,"10th_percentile":8456.01,"90th_percentile":8456.01,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"14","median_amount":8457.51,"10th_percentile":8307.51,"90th_percentile":8471.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":12616.96,"10th_percentile":12616.96,"90th_percentile":12616.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","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":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"1 through 10","median_amount":27340.0,"10th_percentile":22558.47,"90th_percentile":27340.0,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"1 through 10","median_amount":24033.15,"10th_percentile":24033.15,"90th_percentile":24033.15,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":8454.51,"10th_percentile":8369.01,"90th_percentile":8462.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Pacemaker and Similar Procedures","code_information":[{"code":"5223","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"1 through 10","median_amount":28841.82,"10th_percentile":28841.82,"90th_percentile":52114.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":12931.73,"10th_percentile":12931.73,"90th_percentile":14106.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"18","median_amount":10691.08,"10th_percentile":10573.48,"90th_percentile":11371.49,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"1 through 10","median_amount":52837.42,"10th_percentile":52837.42,"90th_percentile":52837.42,"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":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"1 through 10","median_amount":58590.7,"10th_percentile":56875.1,"90th_percentile":59631.46},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":10693.08,"10th_percentile":10691.08,"90th_percentile":13749.25,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"1 through 10","median_amount":57839.87,"10th_percentile":55541.48,"90th_percentile":60601.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":18295.68,"10th_percentile":18295.68,"90th_percentile":18295.68},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"16","median_amount":10694.08,"10th_percentile":10312.21,"90th_percentile":10699.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":12408.72,"10th_percentile":12408.72,"90th_percentile":12408.72,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":12931.73,"10th_percentile":12931.73,"90th_percentile":12931.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":10076.85,"10th_percentile":10076.85,"90th_percentile":10076.85,"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":"Molina Healthcare","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":12875.87,"10th_percentile":12875.87,"90th_percentile":12875.87,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"1 through 10","median_amount":35084.02,"10th_percentile":35084.02,"90th_percentile":35673.0,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"1 through 10","median_amount":32583.0,"10th_percentile":32583.0,"90th_percentile":32583.0,"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":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"18","median_amount":10691.09,"10th_percentile":10020.29,"90th_percentile":10712.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Pacemaker and Similar Procedures","code_information":[{"code":"5224","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"1 through 10","median_amount":4378.04,"10th_percentile":4378.04,"90th_percentile":4378.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":19482.56,"10th_percentile":19482.56,"90th_percentile":19495.68,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"1 through 10","median_amount":95408.6,"10th_percentile":95408.6,"90th_percentile":95408.6,"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":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"1 through 10","median_amount":98890.52,"10th_percentile":98890.52,"90th_percentile":98890.52},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":18313.03,"10th_percentile":18313.03,"90th_percentile":18313.03,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"1 through 10","median_amount":78464.62,"10th_percentile":78464.62,"90th_percentile":101197.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":19335.56,"10th_percentile":19335.56,"90th_percentile":19488.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","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":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":19482.56,"10th_percentile":19115.06,"90th_percentile":19492.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 ICD and Similar Procedures","code_information":[{"code":"5231","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":22941.12,"10th_percentile":22941.12,"90th_percentile":22943.82,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"1 through 10","median_amount":112266.22,"10th_percentile":112266.22,"90th_percentile":112266.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":22933.39,"10th_percentile":22933.39,"90th_percentile":22933.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":27833.19,"10th_percentile":27833.19,"90th_percentile":27833.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","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":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 ICD and Similar Procedures","code_information":[{"code":"5232","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"1 through 10","median_amount":53474.61,"10th_percentile":52189.74,"90th_percentile":76508.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":30458.09,"10th_percentile":30458.09,"90th_percentile":30458.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":32753.2,"10th_percentile":32440.17,"90th_percentile":32764.01,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"1 through 10","median_amount":160332.34,"10th_percentile":160332.34,"90th_percentile":160332.34,"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":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"1 through 10","median_amount":194107.76,"10th_percentile":155685.62,"90th_percentile":251348.35},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":28975.7,"10th_percentile":28975.7,"90th_percentile":28975.7,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":32753.2,"10th_percentile":32753.2,"90th_percentile":32753.2,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":30460.48,"10th_percentile":30460.48,"90th_percentile":30460.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"20","median_amount":160984.11,"10th_percentile":135658.51,"90th_percentile":197807.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":33021.16,"10th_percentile":33021.16,"90th_percentile":33021.16,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":30091.24,"10th_percentile":30091.24,"90th_percentile":30091.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"16","median_amount":32756.2,"10th_percentile":32753.2,"90th_percentile":32761.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":30031.27,"10th_percentile":29323.08,"90th_percentile":31111.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":32886.88,"10th_percentile":32886.88,"90th_percentile":32886.88,"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 Healthcare","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":31734.21,"10th_percentile":31734.21,"90th_percentile":31734.21,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"1 through 10","median_amount":91892.0,"10th_percentile":91892.0,"90th_percentile":91892.0,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"1 through 10","median_amount":102184.0,"10th_percentile":102184.0,"90th_percentile":102184.0,"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":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":30919.97,"10th_percentile":89.96,"90th_percentile":32757.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Blood Product Exchange and Related Services","code_information":[{"code":"5241","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"1 through 10","median_amount":2946.97,"10th_percentile":2045.36,"90th_percentile":14488.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1131.15,"10th_percentile":968.58,"90th_percentile":15350.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"11","median_amount":1132.3,"10th_percentile":1059.98,"90th_percentile":2704.85,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"1 through 10","median_amount":20933.1,"10th_percentile":5889.0,"90th_percentile":92037.39,"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":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"1 through 10","median_amount":8074.05,"10th_percentile":5850.28,"90th_percentile":45638.71},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":2767.83,"10th_percentile":2767.83,"90th_percentile":2767.83,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1416.63,"10th_percentile":1366.63,"90th_percentile":3605.0,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2566.85,"10th_percentile":959.7,"90th_percentile":2566.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"26","median_amount":7238.0,"10th_percentile":5074.59,"90th_percentile":71402.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":2411.08,"10th_percentile":2044.35,"90th_percentile":7664.8},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1345.44,"10th_percentile":1345.44,"90th_percentile":1345.44,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1048.63,"10th_percentile":1048.63,"90th_percentile":1048.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"17","median_amount":1133.6,"10th_percentile":1023.05,"90th_percentile":5960.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1062.18,"10th_percentile":1062.18,"90th_percentile":1062.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"16","median_amount":1048.63,"10th_percentile":995.42,"90th_percentile":1781.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1127.45,"10th_percentile":1127.45,"90th_percentile":1527.06,"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 Healthcare","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":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"1 through 10","median_amount":1513.0,"10th_percentile":1210.4,"90th_percentile":4356.0,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"1 through 10","median_amount":5483.78,"10th_percentile":5483.78,"90th_percentile":5483.78,"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":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1132.32,"10th_percentile":1101.14,"90th_percentile":1152.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Blood Product Exchange and Related Services","code_information":[{"code":"5242","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"1 through 10","median_amount":3797.81,"10th_percentile":3797.81,"90th_percentile":3797.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"29","median_amount":5424.83,"10th_percentile":4697.73,"90th_percentile":5979.08,"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":"BCBS","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"29","median_amount":29.52,"10th_percentile":17.03,"90th_percentile":9715.0},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1260.72,"10th_percentile":1260.72,"90th_percentile":1260.72,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"18","median_amount":5894.14,"10th_percentile":5694.54,"90th_percentile":7122.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"11","median_amount":2071.17,"10th_percentile":1682.8,"90th_percentile":2071.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2368.25,"10th_percentile":2053.69,"90th_percentile":3671.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","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":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"1 through 10","median_amount":825.88,"10th_percentile":825.88,"90th_percentile":1743.84,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Upper GI Procedures","code_information":[{"code":"5301","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"362","median_amount":3830.12,"10th_percentile":1526.06,"90th_percentile":6473.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"105","median_amount":1211.13,"10th_percentile":869.88,"90th_percentile":1237.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"256","median_amount":961.69,"10th_percentile":814.78,"90th_percentile":1499.83,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1093.88,"10th_percentile":1093.88,"90th_percentile":1093.88,"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":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"195","median_amount":7299.14,"10th_percentile":4764.66,"90th_percentile":15696.08,"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":"BCBS","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"559","median_amount":7124.99,"10th_percentile":4679.9,"90th_percentile":13430.53},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":"87","median_amount":1211.13,"10th_percentile":906.05,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"38","median_amount":959.78,"10th_percentile":851.95,"90th_percentile":1878.41,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"28","median_amount":890.74,"10th_percentile":890.74,"90th_percentile":2712.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"1230","median_amount":7566.98,"10th_percentile":5389.7,"90th_percentile":15395.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"138","median_amount":2365.93,"10th_percentile":1106.63,"90th_percentile":4964.49},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"11","median_amount":965.78,"10th_percentile":639.28,"90th_percentile":1485.06,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"94","median_amount":1162.78,"10th_percentile":869.88,"90th_percentile":1744.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"13","median_amount":1036.13,"10th_percentile":867.01,"90th_percentile":1286.63,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"257","median_amount":960.78,"10th_percentile":810.78,"90th_percentile":1426.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"44","median_amount":1112.31,"10th_percentile":942.47,"90th_percentile":2188.03,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"291","median_amount":1162.78,"10th_percentile":880.18,"90th_percentile":1211.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"43","median_amount":961.69,"10th_percentile":855.43,"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":"Molina Healthcare","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":1235.35,"10th_percentile":1186.04,"90th_percentile":1262.3,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"300","median_amount":2664.0,"10th_percentile":1417.13,"90th_percentile":3463.2,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"33","median_amount":2435.0,"10th_percentile":1549.3,"90th_percentile":2947.5,"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":"[APC ($): FEE SCHEDULE]","count":"216","median_amount":958.29,"10th_percentile":727.49,"90th_percentile":1584.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1211.13,"10th_percentile":1211.13,"90th_percentile":1211.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 2 Upper GI Procedures","code_information":[{"code":"5302","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"53","median_amount":7287.0,"10th_percentile":2689.35,"90th_percentile":10285.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"27","median_amount":1444.07,"10th_percentile":906.05,"90th_percentile":3216.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"76","median_amount":1937.91,"10th_percentile":1761.91,"90th_percentile":2869.28,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1550.33,"10th_percentile":1550.33,"90th_percentile":1550.33,"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":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"53","median_amount":8985.95,"10th_percentile":6375.72,"90th_percentile":27846.08,"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":"BCBS","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"116","median_amount":11569.88,"10th_percentile":6892.69,"90th_percentile":22560.46},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":1237.55,"10th_percentile":906.05,"90th_percentile":5349.99,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1937.91,"10th_percentile":1788.35,"90th_percentile":5134.91,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1802.26,"10th_percentile":1802.26,"90th_percentile":5655.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"215","median_amount":11276.07,"10th_percentile":6701.54,"90th_percentile":20602.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"27","median_amount":3160.78,"10th_percentile":2078.7,"90th_percentile":6684.61},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1980.17,"10th_percentile":1980.17,"90th_percentile":1980.17,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"24","median_amount":1211.13,"10th_percentile":869.88,"90th_percentile":2998.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2587.35,"10th_percentile":1749.12,"90th_percentile":3502.94,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"64","median_amount":1937.91,"10th_percentile":1782.28,"90th_percentile":2869.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2946.49,"10th_percentile":2946.49,"90th_percentile":2946.49,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"29","median_amount":1211.13,"10th_percentile":906.05,"90th_percentile":2978.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1558.0,"10th_percentile":1550.33,"90th_percentile":1945.82,"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":"Molina Healthcare","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":1235.35,"10th_percentile":1235.35,"90th_percentile":1235.35,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"47","median_amount":3996.0,"10th_percentile":2664.0,"90th_percentile":4662.0,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"1 through 10","median_amount":3409.0,"10th_percentile":3409.0,"90th_percentile":3654.42,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"37","median_amount":1938.42,"10th_percentile":1550.82,"90th_percentile":3599.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Upper GI Procedures","code_information":[{"code":"5303","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"1 through 10","median_amount":11710.0,"10th_percentile":6345.47,"90th_percentile":14506.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":6587.47,"10th_percentile":6587.47,"90th_percentile":6587.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3893.6,"10th_percentile":3862.1,"90th_percentile":4376.16,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"1 through 10","median_amount":17172.6,"10th_percentile":14511.01,"90th_percentile":27608.31,"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":"BCBS","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"11","median_amount":19419.84,"10th_percentile":9156.12,"90th_percentile":28543.1},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":3216.13,"10th_percentile":3124.29,"90th_percentile":5702.68,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3888.6,"10th_percentile":3888.6,"90th_percentile":3888.6,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3614.54,"10th_percentile":3614.54,"90th_percentile":3614.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"38","median_amount":20534.77,"10th_percentile":13099.91,"90th_percentile":35418.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":7027.48,"10th_percentile":7027.48,"90th_percentile":16073.32},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":3669.13,"10th_percentile":3216.13,"90th_percentile":4824.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"15","median_amount":3886.6,"10th_percentile":3867.1,"90th_percentile":3894.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":3216.13,"10th_percentile":3216.13,"90th_percentile":5349.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","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":3280.45,"10th_percentile":3280.45,"90th_percentile":3280.45,"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":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"1 through 10","median_amount":7357.51,"10th_percentile":7223.0,"90th_percentile":9313.84,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"1 through 10","median_amount":8678.75,"10th_percentile":8678.75,"90th_percentile":8678.75,"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":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3894.11,"10th_percentile":3886.61,"90th_percentile":3894.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Lower GI Procedures","code_information":[{"code":"5311","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"443","median_amount":4038.0,"10th_percentile":1520.61,"90th_percentile":4038.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"40","median_amount":1237.55,"10th_percentile":1188.15,"90th_percentile":1237.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"186","median_amount":931.37,"10th_percentile":931.37,"90th_percentile":931.37,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":931.37,"10th_percentile":931.37,"90th_percentile":931.37,"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":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"230","median_amount":4893.75,"10th_percentile":4471.32,"90th_percentile":5062.36,"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":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"742","median_amount":4890.39,"10th_percentile":4518.91,"90th_percentile":5058.1},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":"37","median_amount":1237.55,"10th_percentile":1188.15,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"30","median_amount":931.37,"10th_percentile":931.37,"90th_percentile":933.37,"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":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"12","median_amount":914.0,"10th_percentile":866.17,"90th_percentile":1195.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"1909","median_amount":4893.22,"10th_percentile":4472.46,"90th_percentile":5066.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"212","median_amount":1705.65,"10th_percentile":1560.09,"90th_percentile":1760.99},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":931.37,"10th_percentile":846.28,"90th_percentile":3233.74,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"37","median_amount":1202.22,"10th_percentile":1188.15,"90th_percentile":1237.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":838.23,"10th_percentile":838.23,"90th_percentile":838.23,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"187","median_amount":931.37,"10th_percentile":931.37,"90th_percentile":931.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1212.8,"10th_percentile":1046.0,"90th_percentile":1214.17,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"87","median_amount":1237.55,"10th_percentile":1188.15,"90th_percentile":1237.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":931.37,"10th_percentile":931.37,"90th_percentile":935.99,"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 Healthcare","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":1262.3,"10th_percentile":1211.91,"90th_percentile":1398.99,"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":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"431","median_amount":1123.0,"10th_percentile":1123.0,"90th_percentile":2664.0,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"48","median_amount":1025.0,"10th_percentile":1025.0,"90th_percentile":4389.99,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"99","median_amount":931.38,"10th_percentile":931.38,"90th_percentile":931.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Lower GI Procedures","code_information":[{"code":"5312","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"862","median_amount":4246.0,"10th_percentile":1966.56,"90th_percentile":6681.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"143","median_amount":1237.55,"10th_percentile":1188.15,"90th_percentile":1856.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"653","median_amount":1204.52,"10th_percentile":1204.52,"90th_percentile":1806.78,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1208.21,"10th_percentile":1208.21,"90th_percentile":1208.21,"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":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"501","median_amount":7324.23,"10th_percentile":6603.32,"90th_percentile":11920.29,"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":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"1552","median_amount":7329.55,"10th_percentile":6603.32,"90th_percentile":11831.0},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":"111","median_amount":1237.55,"10th_percentile":1188.15,"90th_percentile":1856.33,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"109","median_amount":1209.34,"10th_percentile":1204.52,"90th_percentile":2287.68,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"39","median_amount":1565.57,"10th_percentile":1120.2,"90th_percentile":2125.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"4068","median_amount":7340.07,"10th_percentile":6582.93,"90th_percentile":11967.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"482","median_amount":2545.41,"10th_percentile":2279.82,"90th_percentile":4134.8},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"39","median_amount":1329.98,"10th_percentile":1204.52,"90th_percentile":1842.91,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1204.52,"10th_percentile":1204.52,"90th_percentile":1204.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"93","median_amount":1237.55,"10th_percentile":1188.15,"90th_percentile":1856.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"38","median_amount":1196.57,"10th_percentile":1084.07,"90th_percentile":2057.11,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"701","median_amount":1204.52,"10th_percentile":1204.52,"90th_percentile":2089.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"16","median_amount":1481.55,"10th_percentile":1208.21,"90th_percentile":2222.33,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"238","median_amount":1237.55,"10th_percentile":1188.15,"90th_percentile":1856.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"29","median_amount":1228.05,"10th_percentile":1113.6,"90th_percentile":1828.54,"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":"Molina Healthcare","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":1262.3,"10th_percentile":1211.91,"90th_percentile":1893.46,"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":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"902","median_amount":2664.0,"10th_percentile":2664.0,"90th_percentile":4662.0,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"110","median_amount":2435.0,"10th_percentile":2435.0,"90th_percentile":3996.0,"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":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"390","median_amount":1209.52,"10th_percentile":1204.52,"90th_percentile":2285.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Lower GI Procedures","code_information":[{"code":"5313","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"51","median_amount":6180.0,"10th_percentile":4573.95,"90th_percentile":9366.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"24","median_amount":2712.15,"10th_percentile":1806.05,"90th_percentile":3162.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"24","median_amount":2801.55,"10th_percentile":2646.79,"90th_percentile":3198.25,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"50","median_amount":12254.53,"10th_percentile":10172.64,"90th_percentile":17557.78,"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":"BCBS","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"107","median_amount":10668.65,"10th_percentile":7258.02,"90th_percentile":15804.39},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":2744.26,"10th_percentile":1806.05,"90th_percentile":2824.92,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2803.55,"10th_percentile":2801.55,"90th_percentile":3180.99,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2964.14,"10th_percentile":2964.14,"90th_percentile":2974.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"252","median_amount":12087.95,"10th_percentile":7612.4,"90th_percentile":18555.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"32","median_amount":4131.35,"10th_percentile":2552.9,"90th_percentile":8526.03},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2861.07,"10th_percentile":2861.07,"90th_percentile":2861.07,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"11","median_amount":2712.15,"10th_percentile":1806.05,"90th_percentile":2824.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2521.39,"10th_percentile":2521.39,"90th_percentile":2521.39,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"38","median_amount":2801.55,"10th_percentile":2801.55,"90th_percentile":3190.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3445.91,"10th_percentile":3445.91,"90th_percentile":3445.91,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"31","median_amount":2712.15,"10th_percentile":1754.49,"90th_percentile":3036.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2712.15,"10th_percentile":2712.15,"90th_percentile":2712.15,"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":"Molina Healthcare","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":2595.07,"10th_percentile":2491.47,"90th_percentile":2881.42,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"73","median_amount":4712.12,"10th_percentile":2664.0,"90th_percentile":5891.0,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"1 through 10","median_amount":3652.5,"10th_percentile":3409.0,"90th_percentile":5381.68,"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":"[APC ($): FEE SCHEDULE]","count":"26","median_amount":2801.55,"10th_percentile":2801.55,"90th_percentile":3198.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complex GI Procedures","code_information":[{"code":"5331","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"1 through 10","median_amount":13004.5,"10th_percentile":11710.0,"90th_percentile":21824.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":6186.91,"10th_percentile":6186.91,"90th_percentile":9483.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6088.22,"10th_percentile":6088.22,"90th_percentile":6088.22,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"1 through 10","median_amount":36235.28,"10th_percentile":36235.28,"90th_percentile":38144.03,"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":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"1 through 10","median_amount":36220.42,"10th_percentile":23117.4,"90th_percentile":56529.7},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":8566.12,"10th_percentile":7490.28,"90th_percentile":9840.34,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6082.22,"10th_percentile":6082.22,"90th_percentile":6082.22,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4981.44,"10th_percentile":4981.44,"90th_percentile":5655.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"30","median_amount":32446.65,"10th_percentile":20759.45,"90th_percentile":44693.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":9212.95,"10th_percentile":9212.95,"90th_percentile":11363.04},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":6573.61,"10th_percentile":6571.75,"90th_percentile":8454.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"12","median_amount":6081.22,"10th_percentile":5934.22,"90th_percentile":6084.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":5349.99,"10th_percentile":5180.66,"90th_percentile":5349.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","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":5456.99,"10th_percentile":5456.99,"90th_percentile":5456.99,"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":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"1 through 10","median_amount":8836.5,"10th_percentile":6544.64,"90th_percentile":10564.75,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"1 through 10","median_amount":7790.88,"10th_percentile":6204.7,"90th_percentile":8070.0,"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":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6056.73,"10th_percentile":5694.13,"90th_percentile":6089.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Abdominal/Peritoneal/Biliary and Related Procedures","code_information":[{"code":"5341","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"29","median_amount":8010.85,"10th_percentile":4654.8,"90th_percentile":11725.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"11","median_amount":5201.7,"10th_percentile":1911.81,"90th_percentile":5417.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"27","median_amount":3605.18,"10th_percentile":3203.47,"90th_percentile":3994.38,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3797.18,"10th_percentile":3797.18,"90th_percentile":3797.18,"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":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"25","median_amount":15661.36,"10th_percentile":5627.41,"90th_percentile":22067.26,"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":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"59","median_amount":19759.76,"10th_percentile":5701.61,"90th_percentile":25944.84},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":"19","median_amount":4248.36,"10th_percentile":2125.75,"90th_percentile":5417.98,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3611.18,"10th_percentile":3605.18,"90th_percentile":3907.02,"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":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3402.3,"10th_percentile":3369.42,"90th_percentile":3722.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"112","median_amount":19215.36,"10th_percentile":11529.25,"90th_percentile":27026.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"15","median_amount":5411.56,"10th_percentile":3148.33,"90th_percentile":8225.2},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3612.68,"10th_percentile":3612.68,"90th_percentile":3612.68,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":5201.7,"10th_percentile":2702.21,"90th_percentile":6808.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"40","median_amount":3605.18,"10th_percentile":3251.54,"90th_percentile":3810.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5166.95,"10th_percentile":4131.23,"90th_percentile":5166.96,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":5201.7,"10th_percentile":4425.0,"90th_percentile":6471.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"15","median_amount":2884.15,"10th_percentile":2884.15,"90th_percentile":3924.45,"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 Healthcare","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":4513.5,"10th_percentile":4513.5,"90th_percentile":4513.5,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"32","median_amount":8566.0,"10th_percentile":6793.67,"90th_percentile":9076.11,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"1 through 10","median_amount":8022.5,"10th_percentile":7473.83,"90th_percentile":8022.5,"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":"[APC ($): FEE SCHEDULE]","count":"24","median_amount":3605.19,"10th_percentile":3251.55,"90th_percentile":3613.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Abdominal/Peritoneal/Biliary and Related Procedures","code_information":[{"code":"5342","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"1 through 10","median_amount":14050.86,"10th_percentile":14050.86,"90th_percentile":14050.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6697.69,"10th_percentile":6697.69,"90th_percentile":6697.69,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"1 through 10","median_amount":52268.27,"10th_percentile":52268.27,"90th_percentile":52268.27,"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":"BCBS","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"1 through 10","median_amount":24137.21,"10th_percentile":24137.21,"90th_percentile":24137.21},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"13","median_amount":30820.7,"10th_percentile":22036.51,"90th_percentile":40384.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":10804.56,"10th_percentile":9464.21,"90th_percentile":21195.23},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7540.32,"10th_percentile":7540.32,"90th_percentile":7540.32,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":5417.98,"10th_percentile":5417.98,"90th_percentile":5417.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","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":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"1 through 10","median_amount":20183.42,"10th_percentile":20183.42,"90th_percentile":20183.42,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"1 through 10","median_amount":8024.18,"10th_percentile":8024.18,"90th_percentile":8024.18,"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":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Laparoscopy and Related Services","code_information":[{"code":"5361","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"199","median_amount":9691.01,"10th_percentile":7565.0,"90th_percentile":14989.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"35","median_amount":5428.9,"10th_percentile":4311.64,"90th_percentile":7307.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"59","median_amount":5967.21,"10th_percentile":5417.17,"90th_percentile":5978.46,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"110","median_amount":30188.63,"10th_percentile":21900.26,"90th_percentile":46770.42,"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":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"240","median_amount":31943.37,"10th_percentile":22851.33,"90th_percentile":49511.73},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":5445.45,"10th_percentile":4311.64,"90th_percentile":7573.8,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5960.55,"10th_percentile":5428.87,"90th_percentile":10635.8,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5543.93,"10th_percentile":5543.93,"90th_percentile":5543.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"767","median_amount":31311.85,"10th_percentile":22522.94,"90th_percentile":46694.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"79","median_amount":11068.98,"10th_percentile":7254.11,"90th_percentile":14891.8},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5966.71,"10th_percentile":5966.71,"90th_percentile":5967.71,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"32","median_amount":5273.88,"10th_percentile":4248.36,"90th_percentile":6284.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5369.2,"10th_percentile":5369.2,"90th_percentile":5369.2,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"74","median_amount":5961.81,"10th_percentile":5568.21,"90th_percentile":7784.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4354.2,"10th_percentile":4354.2,"90th_percentile":4354.2,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"56","median_amount":5324.01,"10th_percentile":4311.64,"90th_percentile":7661.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5984.54,"10th_percentile":5323.61,"90th_percentile":5985.28,"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":"Molina Healthcare","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":6185.3,"10th_percentile":5139.53,"90th_percentile":8373.24,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"182","median_amount":13046.0,"10th_percentile":10377.0,"90th_percentile":19092.19,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"32","median_amount":11916.0,"10th_percentile":9479.0,"90th_percentile":13047.68,"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":"[APC ($): FEE SCHEDULE]","count":"50","median_amount":5960.72,"10th_percentile":5422.87,"90th_percentile":5984.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Laparoscopy and Related Services","code_information":[{"code":"5362","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"21","median_amount":14148.16,"10th_percentile":9691.0,"90th_percentile":18794.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":7016.18,"10th_percentile":6340.54,"90th_percentile":8267.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"13","median_amount":10635.8,"10th_percentile":10269.03,"90th_percentile":10648.16,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"30","median_amount":44043.93,"10th_percentile":35196.48,"90th_percentile":57287.98,"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":"BCBS","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"50","median_amount":44349.89,"10th_percentile":35430.02,"90th_percentile":60260.95},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":7307.91,"10th_percentile":7307.91,"90th_percentile":8527.07,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":10641.8,"10th_percentile":10636.78,"90th_percentile":10642.8,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":9891.87,"10th_percentile":9891.87,"90th_percentile":9891.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"155","median_amount":42870.4,"10th_percentile":34676.4,"90th_percentile":53738.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"15","median_amount":14345.23,"10th_percentile":11832.94,"90th_percentile":20014.32},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":10642.79,"10th_percentile":10642.79,"90th_percentile":10809.02,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":8579.4,"10th_percentile":8579.4,"90th_percentile":8579.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":9577.72,"10th_percentile":9577.72,"90th_percentile":9577.72,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"11","median_amount":10638.8,"10th_percentile":10243.8,"90th_percentile":10645.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":7307.91,"10th_percentile":2295.06,"90th_percentile":9631.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","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":8218.46,"10th_percentile":8218.46,"90th_percentile":8218.46,"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":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"36","median_amount":13046.0,"10th_percentile":11131.43,"90th_percentile":13265.9,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"1 through 10","median_amount":11916.0,"10th_percentile":11045.17,"90th_percentile":12140.42,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"12","median_amount":10640.81,"10th_percentile":10248.71,"90th_percentile":10644.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Urology and Related Services","code_information":[{"code":"5371","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"1 through 10","median_amount":126.5,"10th_percentile":75.92,"90th_percentile":177.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2786.36,"10th_percentile":2732.25,"90th_percentile":2924.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"35","median_amount":211.19,"10th_percentile":209.26,"90th_percentile":249.47,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":285.67,"10th_percentile":285.67,"90th_percentile":285.67,"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":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"35","median_amount":456.0,"10th_percentile":249.47,"90th_percentile":13283.22,"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":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"1 through 10","median_amount":20382.23,"10th_percentile":20382.23,"90th_percentile":20382.23},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":"16","median_amount":488.51,"10th_percentile":108.22,"90th_percentile":13024.56,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":248.46,"10th_percentile":232.28,"90th_percentile":359.09,"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":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"46","median_amount":499.0,"10th_percentile":387.0,"90th_percentile":14053.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":145.95,"10th_percentile":135.45,"90th_percentile":5054.0},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":469.01,"10th_percentile":103.9,"90th_percentile":488.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"24","median_amount":248.46,"10th_percentile":232.46,"90th_percentile":410.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":980.48,"10th_percentile":980.48,"90th_percentile":980.48,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":108.22,"10th_percentile":103.9,"90th_percentile":488.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":328.18,"10th_percentile":328.18,"90th_percentile":328.18,"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 Healthcare","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":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"1 through 10","median_amount":432.0,"10th_percentile":432.0,"90th_percentile":432.0,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"53","median_amount":248.46,"10th_percentile":248.46,"90th_percentile":248.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Urology and Related Services","code_information":[{"code":"5372","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"55","median_amount":994.0,"10th_percentile":301.51,"90th_percentile":1732.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"16","median_amount":1877.25,"10th_percentile":506.73,"90th_percentile":1955.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"198","median_amount":682.66,"10th_percentile":657.36,"90th_percentile":684.65,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":545.49,"10th_percentile":545.49,"90th_percentile":684.65,"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":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"42","median_amount":1447.0,"10th_percentile":884.26,"90th_percentile":1732.0,"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":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"1 through 10","median_amount":80.01,"10th_percentile":40.0,"90th_percentile":12648.71},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":"16","median_amount":1732.0,"10th_percentile":545.49,"90th_percentile":1955.3,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"30","median_amount":681.86,"10th_percentile":642.02,"90th_percentile":681.86,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"31","median_amount":634.14,"10th_percentile":597.07,"90th_percentile":634.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"340","median_amount":1386.0,"10th_percentile":1093.0,"90th_percentile":1732.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"39","median_amount":452.55,"10th_percentile":337.05,"90th_percentile":699.01},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"18","median_amount":699.01,"10th_percentile":638.52,"90th_percentile":846.01,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"18","median_amount":1699.0,"10th_percentile":486.5,"90th_percentile":1955.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":613.68,"10th_percentile":613.68,"90th_percentile":613.68,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"211","median_amount":681.86,"10th_percentile":648.02,"90th_percentile":694.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1690.68,"10th_percentile":786.97,"90th_percentile":1938.18,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"21","median_amount":1386.0,"10th_percentile":1386.0,"90th_percentile":1873.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":684.65,"10th_percentile":684.65,"90th_percentile":684.65,"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 Healthcare","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":1699.0,"10th_percentile":1699.0,"90th_percentile":1699.0,"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":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"70","median_amount":1010.7,"10th_percentile":432.0,"90th_percentile":1123.0,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"1 through 10","median_amount":1022.75,"10th_percentile":986.0,"90th_percentile":1025.0,"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":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"139","median_amount":681.87,"10th_percentile":642.02,"90th_percentile":683.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Urology and Related Services","code_information":[{"code":"5373","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"65","median_amount":3527.2,"10th_percentile":2329.0,"90th_percentile":5376.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"28","median_amount":2052.49,"10th_percentile":1765.3,"90th_percentile":2758.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"106","median_amount":2093.5,"10th_percentile":1891.11,"90th_percentile":2101.24,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1921.13,"10th_percentile":1921.13,"90th_percentile":1921.13,"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":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"40","median_amount":7991.56,"10th_percentile":2934.0,"90th_percentile":13668.81,"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":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"33","median_amount":13663.88,"10th_percentile":129.11,"90th_percentile":18227.31},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":"16","median_amount":2137.83,"10th_percentile":1955.3,"90th_percentile":2971.46,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"20","median_amount":2092.7,"10th_percentile":1807.7,"90th_percentile":2097.7,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"15","median_amount":1946.21,"10th_percentile":1946.21,"90th_percentile":1946.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"298","median_amount":8480.0,"10th_percentile":3047.0,"90th_percentile":12636.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"53","median_amount":2122.93,"10th_percentile":935.2,"90th_percentile":4632.03},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2053.5,"10th_percentile":2053.5,"90th_percentile":2053.5,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"17","median_amount":1838.7,"10th_percentile":1765.3,"90th_percentile":2425.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"135","median_amount":2092.7,"10th_percentile":1945.7,"90th_percentile":2134.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2329.0,"10th_percentile":2329.0,"90th_percentile":2574.02,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"26","median_amount":2137.83,"10th_percentile":1838.7,"90th_percentile":2474.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3364.88,"10th_percentile":3364.88,"90th_percentile":9877.86,"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 Healthcare","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":1994.41,"10th_percentile":1914.8,"90th_percentile":3030.89,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"92","median_amount":2664.0,"10th_percentile":1731.6,"90th_percentile":5624.1,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"1 through 10","median_amount":2435.0,"10th_percentile":1979.65,"90th_percentile":5891.0,"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":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"108","median_amount":2092.71,"10th_percentile":1705.61,"90th_percentile":2100.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Urology and Related Services","code_information":[{"code":"5374","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"32","median_amount":6192.08,"10th_percentile":4038.0,"90th_percentile":12414.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1955.3,"10th_percentile":1877.25,"90th_percentile":10501.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"49","median_amount":3527.37,"10th_percentile":3285.39,"90th_percentile":3534.16,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"22","median_amount":19805.77,"10th_percentile":14191.03,"90th_percentile":29519.45,"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":"BCBS","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"59","median_amount":20258.42,"10th_percentile":12472.39,"90th_percentile":27119.73},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":2852.84,"10th_percentile":1955.3,"90th_percentile":3726.19,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"12","median_amount":3523.37,"10th_percentile":3498.37,"90th_percentile":3530.87,"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":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3277.02,"10th_percentile":3277.02,"90th_percentile":3277.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"177","median_amount":20189.93,"10th_percentile":12155.52,"90th_percentile":34567.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"14","median_amount":6661.8,"10th_percentile":5393.82,"90th_percentile":8453.22},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2815.87,"10th_percentile":1955.3,"90th_percentile":3597.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3176.03,"10th_percentile":3176.03,"90th_percentile":3176.03,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"60","median_amount":3523.37,"10th_percentile":3265.3,"90th_percentile":3531.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3858.05,"10th_percentile":3858.05,"90th_percentile":4053.04,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"20","median_amount":2851.25,"10th_percentile":1955.3,"90th_percentile":5208.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3278.63,"10th_percentile":3278.63,"90th_percentile":3278.63,"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":"Molina Healthcare","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":3708.27,"10th_percentile":3708.27,"90th_percentile":8903.68,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"46","median_amount":5975.15,"10th_percentile":5581.98,"90th_percentile":13046.0,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"1 through 10","median_amount":5358.97,"10th_percentile":5210.47,"90th_percentile":11475.81,"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":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"35","median_amount":3523.38,"10th_percentile":3136.28,"90th_percentile":3538.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 5 Urology and Related Services","code_information":[{"code":"5375","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"25","median_amount":10811.11,"10th_percentile":6180.0,"90th_percentile":18047.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":5396.26,"10th_percentile":5375.28,"90th_percentile":5555.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"38","median_amount":5201.12,"10th_percentile":5026.25,"90th_percentile":6192.72,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5010.9,"10th_percentile":5010.9,"90th_percentile":5010.9,"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":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"17","median_amount":34084.92,"10th_percentile":28034.94,"90th_percentile":48927.95,"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":"BCBS","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"54","median_amount":31060.07,"10th_percentile":20276.69,"90th_percentile":40008.21},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":5526.29,"10th_percentile":4829.75,"90th_percentile":7179.49,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4863.07,"10th_percentile":4846.55,"90th_percentile":5225.99,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"142","median_amount":30487.78,"10th_percentile":19703.75,"90th_percentile":42662.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"12","median_amount":9559.7,"10th_percentile":7689.98,"90th_percentile":13775.53},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5056.08,"10th_percentile":5056.08,"90th_percentile":5301.95,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":5555.13,"10th_percentile":5548.84,"90th_percentile":6907.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4673.95,"10th_percentile":4673.95,"90th_percentile":4673.95,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"49","median_amount":5196.28,"10th_percentile":4904.18,"90th_percentile":6195.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6093.31,"10th_percentile":6093.31,"90th_percentile":7285.8,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"15","median_amount":5375.28,"10th_percentile":4399.45,"90th_percentile":5555.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5214.48,"10th_percentile":5214.48,"90th_percentile":5214.48,"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":"Molina Healthcare","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":7567.6,"10th_percentile":7567.6,"90th_percentile":7567.6,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"28","median_amount":10377.0,"10th_percentile":8836.5,"90th_percentile":15565.5,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"1 through 10","median_amount":10377.0,"10th_percentile":4098.98,"90th_percentile":13268.86,"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":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"36","median_amount":5212.91,"10th_percentile":5193.29,"90th_percentile":6624.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 6 Urology and Related Services","code_information":[{"code":"5376","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"20","median_amount":9973.0,"10th_percentile":9100.42,"90th_percentile":23099.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":5547.03,"10th_percentile":5547.03,"90th_percentile":9112.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"19","median_amount":9446.62,"10th_percentile":8668.82,"90th_percentile":9466.89,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"11","median_amount":50264.94,"10th_percentile":44483.88,"90th_percentile":54105.25,"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":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"16","median_amount":50952.36,"10th_percentile":48293.91,"90th_percentile":62602.37},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":9455.6,"10th_percentile":8628.7,"90th_percentile":9547.47,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":8787.46,"10th_percentile":8787.46,"90th_percentile":8787.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"69","median_amount":51036.63,"10th_percentile":44427.19,"90th_percentile":55670.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"13","median_amount":16110.68,"10th_percentile":15312.6,"90th_percentile":18754.27},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":9418.81,"10th_percentile":9418.81,"90th_percentile":9418.81,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":8961.96,"10th_percentile":8961.96,"90th_percentile":8961.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":8256.96,"10th_percentile":8256.96,"90th_percentile":8256.96,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"12","median_amount":9449.62,"10th_percentile":9054.62,"90th_percentile":9465.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6902.96,"10th_percentile":6902.96,"90th_percentile":6902.96,"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":"Molina Healthcare","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":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"24","median_amount":10377.0,"10th_percentile":8301.6,"90th_percentile":10405.43,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"1 through 10","median_amount":11549.88,"10th_percentile":11549.88,"90th_percentile":11549.88,"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":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"17","median_amount":9446.63,"10th_percentile":8663.62,"90th_percentile":9454.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 7 Urology and Related Services","code_information":[{"code":"5377","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":13165.8,"10th_percentile":13165.8,"90th_percentile":13165.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","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":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 8 Urology and Related Services","code_information":[{"code":"5378","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"1 through 10","median_amount":2215.63,"10th_percentile":2215.63,"90th_percentile":2215.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":50902.58,"10th_percentile":50902.58,"90th_percentile":50902.58,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"1 through 10","median_amount":97110.83,"10th_percentile":97110.83,"90th_percentile":97110.83},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"1 through 10","median_amount":58416.35,"10th_percentile":58416.35,"90th_percentile":58416.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":28910.42,"10th_percentile":28910.42,"90th_percentile":28910.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":20565.76,"10th_percentile":20415.76,"90th_percentile":20703.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","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":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"1 through 10","median_amount":40002.0,"10th_percentile":40002.0,"90th_percentile":40002.0,"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":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":20176.02,"10th_percentile":20176.02,"90th_percentile":20176.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Dialysis","code_information":[{"code":"5401","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2069.02,"10th_percentile":2069.02,"90th_percentile":2069.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2704.85,"10th_percentile":2704.85,"90th_percentile":2704.85,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"1 through 10","median_amount":27501.87,"10th_percentile":27501.87,"90th_percentile":27501.87},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":3032.16,"10th_percentile":3032.16,"90th_percentile":3032.16,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"1 through 10","median_amount":2381.13,"10th_percentile":2381.13,"90th_percentile":15071.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2459.3,"10th_percentile":2459.3,"90th_percentile":2459.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2904.91,"10th_percentile":2904.91,"90th_percentile":2904.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2827.66,"10th_percentile":2827.66,"90th_percentile":2827.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2715.9,"10th_percentile":2715.9,"90th_percentile":2715.9,"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 Healthcare","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":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2370.05,"10th_percentile":1975.09,"90th_percentile":2704.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Gynecologic Procedures","code_information":[{"code":"5411","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"139","median_amount":1892.16,"10th_percentile":671.04,"90th_percentile":4497.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"157","median_amount":243.04,"10th_percentile":233.34,"90th_percentile":1098.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":297.86,"10th_percentile":297.86,"90th_percentile":297.86,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":338.53,"10th_percentile":338.53,"90th_percentile":657.56,"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":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"99","median_amount":2592.0,"10th_percentile":1585.0,"90th_percentile":8604.18,"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":"BCBS","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"92","median_amount":2297.28,"10th_percentile":1445.28,"90th_percentile":3827.36},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"1 through 10","median_amount":3654.54,"10th_percentile":3654.54,"90th_percentile":3654.54,"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":"BCBS","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":"233","median_amount":243.04,"10th_percentile":233.34,"90th_percentile":1423.33,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":313.56,"10th_percentile":174.17,"90th_percentile":522.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"592","median_amount":2648.0,"10th_percentile":1585.0,"90th_percentile":7969.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"77","median_amount":812.0,"10th_percentile":550.3,"90th_percentile":3197.4},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"145","median_amount":243.04,"10th_percentile":233.34,"90th_percentile":944.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":420.15,"10th_percentile":420.15,"90th_percentile":3776.04,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"314","median_amount":243.04,"10th_percentile":233.34,"90th_percentile":1215.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","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":"68","median_amount":247.9,"10th_percentile":238.01,"90th_percentile":1451.8,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"186","median_amount":1267.1,"10th_percentile":351.0,"90th_percentile":3977.0,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"11","median_amount":1609.3,"10th_percentile":575.2,"90th_percentile":2967.0,"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":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":219.49,"10th_percentile":206.51,"90th_percentile":626.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":491.44,"10th_percentile":491.44,"90th_percentile":491.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 2 Gynecologic Procedures","code_information":[{"code":"5412","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"1 through 10","median_amount":9691.0,"10th_percentile":9691.0,"90th_percentile":9691.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":208.5,"10th_percentile":208.5,"90th_percentile":533.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"1 through 10","median_amount":10485.19,"10th_percentile":10485.19,"90th_percentile":10485.19,"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":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"1 through 10","median_amount":2345.86,"10th_percentile":2345.86,"90th_percentile":2345.86},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":2109.46,"10th_percentile":188.84,"90th_percentile":4345.46,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":288.99,"10th_percentile":288.99,"90th_percentile":288.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"15","median_amount":5762.21,"10th_percentile":2301.0,"90th_percentile":12041.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":1623.68,"10th_percentile":1623.68,"90th_percentile":1623.68},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":654.43,"10th_percentile":654.43,"90th_percentile":654.43,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1086.32,"10th_percentile":1086.32,"90th_percentile":1086.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":882.6,"10th_percentile":882.6,"90th_percentile":882.6,"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 Healthcare","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":653.95,"10th_percentile":653.95,"90th_percentile":653.95,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"1 through 10","median_amount":367.19,"10th_percentile":277.37,"90th_percentile":1513.0,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"1 through 10","median_amount":1382.0,"10th_percentile":1382.0,"90th_percentile":1382.0,"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":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Gynecologic Procedures","code_information":[{"code":"5413","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"15","median_amount":5555.08,"10th_percentile":2960.2,"90th_percentile":7348.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":724.51,"10th_percentile":724.51,"90th_percentile":724.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"12","median_amount":6557.0,"10th_percentile":5299.85,"90th_percentile":13634.0,"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":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"1 through 10","median_amount":3900.94,"10th_percentile":3367.0,"90th_percentile":8165.0},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":850.94,"10th_percentile":724.51,"90th_percentile":5935.0,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":957.88,"10th_percentile":957.88,"90th_percentile":957.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"56","median_amount":6174.0,"10th_percentile":3367.0,"90th_percentile":10141.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":2181.2,"10th_percentile":1282.4,"90th_percentile":5202.75},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1356.68,"10th_percentile":1356.68,"90th_percentile":1356.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1274.78,"10th_percentile":1274.78,"90th_percentile":1274.78,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1059.74,"10th_percentile":724.51,"90th_percentile":1114.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":825.75,"10th_percentile":825.75,"90th_percentile":825.75,"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 Healthcare","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":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"17","median_amount":1123.0,"10th_percentile":935.1,"90th_percentile":1123.0,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"1 through 10","median_amount":1025.0,"10th_percentile":1025.0,"90th_percentile":1025.0,"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":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":711.62,"10th_percentile":711.62,"90th_percentile":711.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Gynecologic Procedures","code_information":[{"code":"5414","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"127","median_amount":6165.15,"10th_percentile":3348.0,"90th_percentile":10548.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"22","median_amount":2802.11,"10th_percentile":2171.47,"90th_percentile":3489.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"26","median_amount":3253.12,"10th_percentile":2918.62,"90th_percentile":3261.38,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2918.62,"10th_percentile":2918.62,"90th_percentile":2918.62,"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":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"104","median_amount":13465.24,"10th_percentile":6524.08,"90th_percentile":20500.1,"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":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"164","median_amount":13665.65,"10th_percentile":10449.23,"90th_percentile":18495.81},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":2918.62,"10th_percentile":2084.78,"90th_percentile":3349.91,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2935.8,"10th_percentile":2935.8,"90th_percentile":3248.46,"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":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3020.75,"10th_percentile":3020.75,"90th_percentile":3035.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"588","median_amount":13078.82,"10th_percentile":5645.14,"90th_percentile":18943.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"78","median_amount":4357.18,"10th_percentile":1863.99,"90th_percentile":7523.29},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3446.19,"10th_percentile":3446.19,"90th_percentile":3446.19,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"20","median_amount":2171.47,"10th_percentile":1757.62,"90th_percentile":3059.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"24","median_amount":3248.12,"10th_percentile":2918.62,"90th_percentile":3256.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2860.25,"10th_percentile":2860.25,"90th_percentile":2860.25,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"65","median_amount":2802.11,"10th_percentile":846.03,"90th_percentile":2918.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","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":2976.99,"10th_percentile":2169.46,"90th_percentile":3405.33,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"175","median_amount":5624.0,"10th_percentile":2815.2,"90th_percentile":5994.78,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"21","median_amount":5096.2,"10th_percentile":2794.2,"90th_percentile":5452.02,"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":"[APC ($): FEE SCHEDULE]","count":"25","median_amount":3218.13,"10th_percentile":2750.07,"90th_percentile":3251.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 5 Gynecologic Procedures","code_information":[{"code":"5415","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"28","median_amount":8234.56,"10th_percentile":5360.0,"90th_percentile":15575.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":4321.61,"10th_percentile":4321.61,"90th_percentile":4500.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5050.72,"10th_percentile":4991.36,"90th_percentile":5058.0,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"18","median_amount":23376.34,"10th_percentile":18911.49,"90th_percentile":36830.08,"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":"BCBS","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"37","median_amount":24248.8,"10th_percentile":16470.79,"90th_percentile":28687.65},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":5168.72,"10th_percentile":3962.15,"90th_percentile":6957.55,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5067.9,"10th_percentile":5067.9,"90th_percentile":5067.9,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7025.53,"10th_percentile":7025.53,"90th_percentile":7025.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"116","median_amount":23095.37,"10th_percentile":15906.86,"90th_percentile":29918.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"11","median_amount":6048.94,"10th_percentile":4805.21,"90th_percentile":13895.97},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2835.28,"10th_percentile":2835.28,"90th_percentile":7242.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5045.93,"10th_percentile":4895.93,"90th_percentile":7407.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":5168.72,"10th_percentile":4962.39,"90th_percentile":5575.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5063.52,"10th_percentile":5063.52,"90th_percentile":5063.52,"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":"Molina Healthcare","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":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"32","median_amount":8433.82,"10th_percentile":4712.8,"90th_percentile":12804.85,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"1 through 10","median_amount":11740.5,"10th_percentile":11740.5,"90th_percentile":11740.5,"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":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4679.19,"10th_percentile":4675.44,"90th_percentile":4797.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 6 Gynecologic Procedures","code_information":[{"code":"5416","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"1 through 10","median_amount":20185.91,"10th_percentile":20185.91,"90th_percentile":20185.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7558.33,"10th_percentile":7511.57,"90th_percentile":7564.92,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"1 through 10","median_amount":42735.8,"10th_percentile":42735.8,"90th_percentile":42735.8,"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":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"1 through 10","median_amount":56008.24,"10th_percentile":56008.24,"90th_percentile":56008.24},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7101.95,"10th_percentile":7101.95,"90th_percentile":7101.95,"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":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"1 through 10","median_amount":34045.23,"10th_percentile":24807.94,"90th_percentile":51884.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":3704.37,"10th_percentile":3704.37,"90th_percentile":3704.37},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6804.4,"10th_percentile":6804.4,"90th_percentile":6804.4,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7407.33,"10th_percentile":7407.33,"90th_percentile":7560.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":7601.31,"10th_percentile":7601.31,"90th_percentile":7601.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","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":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"1 through 10","median_amount":15565.5,"10th_percentile":15565.5,"90th_percentile":17707.0,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Nerve Procedures","code_information":[{"code":"5431","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"25","median_amount":4038.0,"10th_percentile":1542.7,"90th_percentile":7509.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"11","median_amount":1690.8,"10th_percentile":1623.31,"90th_percentile":4217.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"57","median_amount":1994.9,"10th_percentile":1787.8,"90th_percentile":2002.4,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"21","median_amount":7491.15,"10th_percentile":4160.85,"90th_percentile":13963.33,"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":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"54","median_amount":7873.53,"10th_percentile":5743.32,"90th_percentile":21023.81},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":1690.8,"10th_percentile":1606.85,"90th_percentile":3246.61,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"12","median_amount":1994.9,"10th_percentile":1814.63,"90th_percentile":2002.4,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1855.26,"10th_percentile":1855.25,"90th_percentile":1855.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"109","median_amount":7927.52,"10th_percentile":4941.48,"90th_percentile":19202.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"18","median_amount":3680.84,"10th_percentile":1212.59,"90th_percentile":9964.86},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2001.4,"10th_percentile":1863.29,"90th_percentile":2038.29,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"11","median_amount":1606.85,"10th_percentile":1560.96,"90th_percentile":1690.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1800.41,"10th_percentile":1800.41,"90th_percentile":1800.41,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"49","median_amount":1994.9,"10th_percentile":1602.9,"90th_percentile":2002.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"22","median_amount":1690.8,"10th_percentile":1606.85,"90th_percentile":2410.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1623.31,"10th_percentile":1606.85,"90th_percentile":1690.8,"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 Healthcare","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":1638.99,"10th_percentile":1638.99,"90th_percentile":1638.99,"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":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"30","median_amount":5891.0,"10th_percentile":3715.81,"90th_percentile":8944.5,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"1 through 10","median_amount":5380.0,"10th_percentile":5380.0,"90th_percentile":5380.0,"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":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"42","median_amount":1994.9,"10th_percentile":1606.85,"90th_percentile":2002.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Nerve Procedures","code_information":[{"code":"5432","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"1 through 10","median_amount":19413.91,"10th_percentile":19413.91,"90th_percentile":19413.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6549.22,"10th_percentile":6549.22,"90th_percentile":6549.22,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"1 through 10","median_amount":36040.22,"10th_percentile":36040.22,"90th_percentile":36040.22,"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":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"1 through 10","median_amount":69210.7,"10th_percentile":69210.7,"90th_percentile":69210.7},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":7689.19,"10th_percentile":7689.19,"90th_percentile":7689.19,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"1 through 10","median_amount":57385.75,"10th_percentile":57385.75,"90th_percentile":58741.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6150.22,"10th_percentile":6150.22,"90th_percentile":6150.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","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":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"1 through 10","median_amount":9957.53,"10th_percentile":9957.53,"90th_percentile":9957.53,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"1 through 10","median_amount":9735.2,"10th_percentile":9735.2,"90th_percentile":9735.2,"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":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Nerve Injections","code_information":[{"code":"5441","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"60","median_amount":1273.9,"10th_percentile":417.34,"90th_percentile":2955.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"25","median_amount":500.96,"10th_percentile":309.14,"90th_percentile":1071.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"132","median_amount":302.36,"10th_percentile":262.36,"90th_percentile":534.96,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"41","median_amount":434.98,"10th_percentile":245.01,"90th_percentile":586.37,"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":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"105","median_amount":2426.27,"10th_percentile":1242.72,"90th_percentile":3411.01,"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":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"80","median_amount":2247.63,"10th_percentile":972.88,"90th_percentile":3666.64},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":655.53,"10th_percentile":309.14,"90th_percentile":892.56,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"47","median_amount":301.56,"10th_percentile":278.37,"90th_percentile":459.84,"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":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"449","median_amount":402.89,"10th_percentile":280.45,"90th_percentile":660.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"372","median_amount":2393.09,"10th_percentile":1218.52,"90th_percentile":3339.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"51","median_amount":398.21,"10th_percentile":118.65,"90th_percentile":982.06},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":137.6,"10th_percentile":137.6,"90th_percentile":137.6,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"23","median_amount":445.2,"10th_percentile":302.79,"90th_percentile":879.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":271.4,"10th_percentile":247.1,"90th_percentile":274.79,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"114","median_amount":308.87,"10th_percentile":187.56,"90th_percentile":1086.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"145","median_amount":466.45,"10th_percentile":320.0,"90th_percentile":1020.9,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"50","median_amount":500.96,"10th_percentile":309.14,"90th_percentile":1028.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"189","median_amount":201.82,"10th_percentile":18.89,"90th_percentile":586.37,"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 Healthcare","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":315.32,"10th_percentile":209.92,"90th_percentile":315.32,"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":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"56","median_amount":432.0,"10th_percentile":284.22,"90th_percentile":1339.0,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"1 through 10","median_amount":2531.0,"10th_percentile":2531.0,"90th_percentile":2539.0,"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":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"88","median_amount":301.56,"10th_percentile":84.84,"90th_percentile":454.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Nerve Injections","code_information":[{"code":"5442","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"181","median_amount":3130.66,"10th_percentile":874.91,"90th_percentile":21018.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"65","median_amount":959.35,"10th_percentile":921.05,"90th_percentile":11063.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"290","median_amount":711.46,"10th_percentile":601.35,"90th_percentile":13460.72,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"180","median_amount":3282.69,"10th_percentile":2231.49,"90th_percentile":70156.6,"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":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"309","median_amount":3307.27,"10th_percentile":2757.83,"90th_percentile":65536.51},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"1 through 10","median_amount":78925.28,"10th_percentile":78925.28,"90th_percentile":78925.28,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"108","median_amount":959.35,"10th_percentile":500.96,"90th_percentile":14133.92,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"46","median_amount":707.46,"10th_percentile":658.46,"90th_percentile":13627.16,"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":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"33","median_amount":780.38,"10th_percentile":657.94,"90th_percentile":6786.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"990","median_amount":3404.41,"10th_percentile":2760.39,"90th_percentile":65618.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"99","median_amount":1248.93,"10th_percentile":639.06,"90th_percentile":26385.12},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":725.11,"10th_percentile":550.11,"90th_percentile":1096.42,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":12191.04,"10th_percentile":12191.04,"90th_percentile":12191.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"69","median_amount":959.35,"10th_percentile":921.05,"90th_percentile":14105.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":641.72,"10th_percentile":391.72,"90th_percentile":12301.3,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"284","median_amount":710.46,"10th_percentile":495.3,"90th_percentile":13452.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"16","median_amount":944.0,"10th_percentile":877.98,"90th_percentile":7545.12,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"117","median_amount":959.35,"10th_percentile":863.41,"90th_percentile":10812.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"13","median_amount":710.35,"10th_percentile":710.35,"90th_percentile":13589.16,"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 Healthcare","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":4604.2,"10th_percentile":939.47,"90th_percentile":16013.64,"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":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"245","median_amount":1123.0,"10th_percentile":901.5,"90th_percentile":21720.4,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"19","median_amount":1025.0,"10th_percentile":161.98,"90th_percentile":19830.5,"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":"[APC ($): FEE SCHEDULE]","count":"189","median_amount":710.35,"10th_percentile":462.47,"90th_percentile":12877.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Nerve Injections","code_information":[{"code":"5443","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"201","median_amount":2350.32,"10th_percentile":1170.97,"90th_percentile":10463.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"78","median_amount":959.35,"10th_percentile":921.05,"90th_percentile":1606.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"318","median_amount":915.4,"10th_percentile":850.3,"90th_percentile":3314.6,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"229","median_amount":2688.88,"10th_percentile":1800.12,"90th_percentile":31377.13,"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":"BCBS","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"359","median_amount":3140.95,"10th_percentile":2314.76,"90th_percentile":33639.09},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":"63","median_amount":1355.88,"10th_percentile":921.05,"90th_percentile":8231.28,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"57","median_amount":914.0,"10th_percentile":909.5,"90th_percentile":1364.25,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"22","median_amount":959.35,"10th_percentile":845.84,"90th_percentile":12224.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"1031","median_amount":2690.46,"10th_percentile":2239.52,"90th_percentile":30956.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"100","median_amount":932.49,"10th_percentile":474.56,"90th_percentile":5198.09},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"14","median_amount":916.5,"10th_percentile":591.0,"90th_percentile":7448.6,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"58","median_amount":959.35,"10th_percentile":921.05,"90th_percentile":6408.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":824.04,"10th_percentile":573.47,"90th_percentile":6573.05,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"315","median_amount":912.5,"10th_percentile":762.5,"90th_percentile":1372.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1411.62,"10th_percentile":914.75,"90th_percentile":23067.46,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"110","median_amount":1381.57,"10th_percentile":921.05,"90th_percentile":7902.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"16","median_amount":1369.82,"10th_percentile":913.21,"90th_percentile":7327.62,"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":"Molina Healthcare","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":1467.8,"10th_percentile":978.54,"90th_percentile":8821.59,"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":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"252","median_amount":1123.0,"10th_percentile":988.12,"90th_percentile":6010.67,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"26","median_amount":1025.0,"10th_percentile":717.5,"90th_percentile":16450.92,"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":"[APC ($): FEE SCHEDULE]","count":"237","median_amount":917.0,"10th_percentile":669.4,"90th_percentile":7305.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Neurostimulator and Related Procedures","code_information":[{"code":"5461","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"1 through 10","median_amount":5738.22,"10th_percentile":5738.22,"90th_percentile":5738.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3513.19,"10th_percentile":3513.19,"90th_percentile":3513.19,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"1 through 10","median_amount":26491.65,"10th_percentile":26491.65,"90th_percentile":26491.65},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"1 through 10","median_amount":23930.3,"10th_percentile":21035.48,"90th_percentile":34368.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3516.19,"10th_percentile":3513.19,"90th_percentile":17251.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":4190.62,"10th_percentile":4190.62,"90th_percentile":4190.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","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":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3528.04,"10th_percentile":3528.04,"90th_percentile":3528.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Neurostimulator and Related Procedures","code_information":[{"code":"5462","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"1 through 10","median_amount":6752.4,"10th_percentile":5529.87,"90th_percentile":10946.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":8394.98,"10th_percentile":8073.61,"90th_percentile":11137.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6704.47,"10th_percentile":6508.47,"90th_percentile":7031.9,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"1 through 10","median_amount":22038.25,"10th_percentile":21501.3,"90th_percentile":37830.89,"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":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"1 through 10","median_amount":36154.0,"10th_percentile":33255.88,"90th_percentile":39715.09},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":11137.29,"10th_percentile":10023.56,"90th_percentile":11356.54,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6655.47,"10th_percentile":6655.47,"90th_percentile":6655.47,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":101.03,"10th_percentile":101.03,"90th_percentile":101.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"30","median_amount":29660.5,"10th_percentile":20314.58,"90th_percentile":41941.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":4876.59,"10th_percentile":4876.59,"90th_percentile":4876.59},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6710.97,"10th_percentile":6710.97,"90th_percentile":6710.97,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":11132.93,"10th_percentile":11132.93,"90th_percentile":11356.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6704.47,"10th_percentile":6459.47,"90th_percentile":12747.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":7372.11,"10th_percentile":7372.11,"90th_percentile":7372.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","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":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"1 through 10","median_amount":13046.0,"10th_percentile":13046.0,"90th_percentile":17200.28,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5363.58,"10th_percentile":5363.58,"90th_percentile":5363.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Neurostimulator and Related Procedures","code_information":[{"code":"5463","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":12935.86,"10th_percentile":12935.86,"90th_percentile":12935.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","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":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Neurostimulator and Related Procedures","code_information":[{"code":"5464","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"1 through 10","median_amount":26459.59,"10th_percentile":26459.59,"90th_percentile":34859.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":23695.96,"10th_percentile":23695.96,"90th_percentile":29719.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":21906.98,"10th_percentile":21906.98,"90th_percentile":21934.41,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"1 through 10","median_amount":88984.98,"10th_percentile":80043.27,"90th_percentile":166009.46},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":20373.49,"10th_percentile":20373.49,"90th_percentile":20373.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"11","median_amount":88114.91,"10th_percentile":67820.93,"90th_percentile":109507.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":42771.54,"10th_percentile":42771.54,"90th_percentile":42771.54},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":22124.02,"10th_percentile":22124.02,"90th_percentile":22124.02,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":21909.98,"10th_percentile":21909.98,"90th_percentile":21914.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":53397.31,"10th_percentile":53397.31,"90th_percentile":53397.31,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":12006.77,"10th_percentile":12006.77,"90th_percentile":12006.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":22750.02,"10th_percentile":22750.02,"90th_percentile":22750.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","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":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"1 through 10","median_amount":70933.0,"10th_percentile":63662.24,"90th_percentile":73554.5,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"1 through 10","median_amount":44901.49,"10th_percentile":44901.49,"90th_percentile":44901.49,"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":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":21937.06,"10th_percentile":21914.48,"90th_percentile":21943.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 5 Neurostimulator and Related Procedures","code_information":[{"code":"5465","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"1 through 10","median_amount":35604.38,"10th_percentile":32929.57,"90th_percentile":61343.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":26265.56,"10th_percentile":25382.02,"90th_percentile":29087.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":31130.95,"10th_percentile":31130.95,"90th_percentile":34298.09,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"1 through 10","median_amount":119874.99,"10th_percentile":110624.43,"90th_percentile":201330.01,"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":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"1 through 10","median_amount":128028.33,"10th_percentile":125854.5,"90th_percentile":134419.35},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":27381.74,"10th_percentile":27381.74,"90th_percentile":52422.36,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":30835.95,"10th_percentile":30835.95,"90th_percentile":30835.95,"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":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":28951.79,"10th_percentile":28951.79,"90th_percentile":28951.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"37","median_amount":124546.47,"10th_percentile":35075.28,"90th_percentile":145280.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":44176.03,"10th_percentile":41520.79,"90th_percentile":68444.96},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":31137.45,"10th_percentile":31137.45,"90th_percentile":31137.45,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":27107.96,"10th_percentile":26518.87,"90th_percentile":52422.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"13","median_amount":31138.95,"10th_percentile":30885.95,"90th_percentile":34151.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":25588.95,"10th_percentile":25588.95,"90th_percentile":29903.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","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":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"1 through 10","median_amount":57263.0,"10th_percentile":57263.0,"90th_percentile":113667.0,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":30885.96,"10th_percentile":30743.86,"90th_percentile":37273.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Implantation of Drug Infusion Device","code_information":[{"code":"5471","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":18063.38,"10th_percentile":18063.38,"90th_percentile":18063.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","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":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Laser Eye Procedures","code_information":[{"code":"5481","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"57","median_amount":665.0,"10th_percentile":278.82,"90th_percentile":735.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"57","median_amount":1265.51,"10th_percentile":686.07,"90th_percentile":1288.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"146","median_amount":561.03,"10th_percentile":520.54,"90th_percentile":562.72,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":562.72,"10th_percentile":562.72,"90th_percentile":562.72,"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":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"24","median_amount":665.0,"10th_percentile":527.54,"90th_percentile":797.0,"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":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"1 through 10","median_amount":597.0,"10th_percentile":597.0,"90th_percentile":597.0},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":"33","median_amount":665.0,"10th_percentile":665.0,"90th_percentile":735.0,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"23","median_amount":560.43,"10th_percentile":560.43,"90th_percentile":560.43,"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":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"24","median_amount":521.2,"10th_percentile":508.06,"90th_percentile":643.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"200","median_amount":665.0,"10th_percentile":529.0,"90th_percentile":735.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"39","median_amount":232.75,"10th_percentile":221.11,"90th_percentile":257.25},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":575.14,"10th_percentile":566.93,"90th_percentile":1236.72,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"42","median_amount":735.0,"10th_percentile":665.0,"90th_percentile":735.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":504.39,"10th_percentile":504.39,"90th_percentile":504.39,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"195","median_amount":560.43,"10th_percentile":560.43,"90th_percentile":560.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"21","median_amount":665.0,"10th_percentile":584.27,"90th_percentile":735.0,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"96","median_amount":665.0,"10th_percentile":662.67,"90th_percentile":735.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":562.72,"10th_percentile":476.67,"90th_percentile":562.72,"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":"Molina Healthcare","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":661.5,"10th_percentile":616.5,"90th_percentile":735.0,"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":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"53","median_amount":665.0,"10th_percentile":360.0,"90th_percentile":735.0,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"1 through 10","median_amount":665.0,"10th_percentile":665.0,"90th_percentile":665.0,"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":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"123","median_amount":560.44,"10th_percentile":560.44,"90th_percentile":562.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Intraocular Procedures","code_information":[{"code":"5491","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"105","median_amount":9923.66,"10th_percentile":3522.93,"90th_percentile":10156.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"66","median_amount":2143.33,"10th_percentile":2057.77,"90th_percentile":2143.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"429","median_amount":2335.89,"10th_percentile":2036.93,"90th_percentile":2341.64,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1863.94,"10th_percentile":1863.94,"90th_percentile":1863.94,"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":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"46","median_amount":17652.47,"10th_percentile":15724.72,"90th_percentile":20922.15,"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":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"195","median_amount":16239.07,"10th_percentile":15276.06,"90th_percentile":20318.01},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":"32","median_amount":2143.33,"10th_percentile":2057.77,"90th_percentile":2143.33,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"62","median_amount":2335.93,"10th_percentile":2325.93,"90th_percentile":3330.93,"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":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"26","median_amount":2166.84,"10th_percentile":2143.33,"90th_percentile":2166.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"371","median_amount":16387.73,"10th_percentile":14601.3,"90th_percentile":19923.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"45","median_amount":5608.17,"10th_percentile":4657.79,"90th_percentile":7462.11},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"24","median_amount":2336.43,"10th_percentile":2163.79,"90th_percentile":2459.03,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"96","median_amount":2143.33,"10th_percentile":2057.77,"90th_percentile":2143.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"18","median_amount":2101.94,"10th_percentile":2048.44,"90th_percentile":2111.94,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"423","median_amount":2332.93,"10th_percentile":2182.93,"90th_percentile":2595.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"18","median_amount":2292.65,"10th_percentile":2109.04,"90th_percentile":2721.32,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1863.94,"10th_percentile":1863.94,"90th_percentile":1863.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"56","median_amount":2143.33,"10th_percentile":2057.77,"90th_percentile":2143.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"24","median_amount":2143.33,"10th_percentile":2057.77,"90th_percentile":2143.33,"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":"Molina Healthcare","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":2186.2,"10th_percentile":2123.77,"90th_percentile":2186.2,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"106","median_amount":5891.0,"10th_percentile":3447.35,"90th_percentile":5891.0,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"1 through 10","median_amount":5380.0,"10th_percentile":5205.71,"90th_percentile":5380.0,"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":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"300","median_amount":2330.44,"10th_percentile":1962.44,"90th_percentile":2428.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Intraocular Procedures","code_information":[{"code":"5492","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"28","median_amount":9691.0,"10th_percentile":6709.62,"90th_percentile":13192.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"25","median_amount":3811.04,"10th_percentile":3766.45,"90th_percentile":3923.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"44","median_amount":4115.14,"10th_percentile":3766.64,"90th_percentile":4122.53,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"22","median_amount":24551.42,"10th_percentile":20078.05,"90th_percentile":28249.07,"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":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"52","median_amount":27557.88,"10th_percentile":20842.38,"90th_percentile":35557.63},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":3811.04,"10th_percentile":1851.99,"90th_percentile":3923.05,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4117.14,"10th_percentile":4109.64,"90th_percentile":4195.33,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3821.96,"10th_percentile":3821.96,"90th_percentile":3821.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"102","median_amount":26193.92,"10th_percentile":21395.44,"90th_percentile":33111.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"13","median_amount":8440.6,"10th_percentile":6171.81,"90th_percentile":11217.63},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3804.73,"10th_percentile":3804.73,"90th_percentile":3804.73,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":3811.04,"10th_percentile":3766.45,"90th_percentile":3923.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6859.94,"10th_percentile":6859.94,"90th_percentile":6859.94,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"55","median_amount":4032.62,"10th_percentile":3717.64,"90th_percentile":4117.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4043.89,"10th_percentile":4043.89,"90th_percentile":4043.89,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":3923.05,"10th_percentile":3766.45,"90th_percentile":3923.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3923.05,"10th_percentile":3923.05,"90th_percentile":3923.05,"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 Healthcare","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":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"26","median_amount":10377.0,"10th_percentile":6783.91,"90th_percentile":16766.95,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"1 through 10","median_amount":9095.42,"10th_percentile":8070.0,"90th_percentile":10377.0,"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":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"38","median_amount":3977.54,"10th_percentile":3287.72,"90th_percentile":4118.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Intraocular Procedures","code_information":[{"code":"5493","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"1 through 10","median_amount":9863.5,"10th_percentile":8828.71,"90th_percentile":11310.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":3923.05,"10th_percentile":3766.45,"90th_percentile":4994.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5278.01,"10th_percentile":5278.01,"90th_percentile":5278.01,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"12","median_amount":31422.07,"10th_percentile":25306.2,"90th_percentile":37897.9},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":3923.05,"10th_percentile":3923.05,"90th_percentile":5884.58,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5278.51,"10th_percentile":5278.51,"90th_percentile":5278.51,"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":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"18","median_amount":32211.85,"10th_percentile":24496.64,"90th_percentile":41032.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":11517.1,"10th_percentile":11517.1,"90th_percentile":11517.1},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":3923.05,"10th_percentile":3766.45,"90th_percentile":5649.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5274.01,"10th_percentile":5124.01,"90th_percentile":5279.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":3766.45,"10th_percentile":3766.45,"90th_percentile":4009.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","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":4001.51,"10th_percentile":4001.51,"90th_percentile":4001.51,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"11","median_amount":10377.0,"10th_percentile":7896.5,"90th_percentile":10377.0,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"1 through 10","median_amount":10696.5,"10th_percentile":10696.5,"90th_percentile":10696.5,"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":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5278.51,"10th_percentile":5271.01,"90th_percentile":5278.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Intraocular Procedures","code_information":[{"code":"5494","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":9051.56,"10th_percentile":9051.56,"90th_percentile":9051.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","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":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Extraocular, Repair, and Plastic Eye Procedures","code_information":[{"code":"5501","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"27","median_amount":333.0,"10th_percentile":210.54,"90th_percentile":541.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"19","median_amount":544.2,"10th_percentile":348.32,"90th_percentile":544.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"43","median_amount":326.34,"10th_percentile":305.38,"90th_percentile":327.67,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":459.94,"10th_percentile":459.94,"90th_percentile":459.94,"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":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"15","median_amount":301.45,"10th_percentile":299.53,"90th_percentile":780.76,"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":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"1 through 10","median_amount":333.0,"10th_percentile":8.83,"90th_percentile":11639.66},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":333.0,"10th_percentile":333.0,"90th_percentile":544.2,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":305.38,"10th_percentile":305.38,"90th_percentile":458.07,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":326.34,"10th_percentile":284.0,"90th_percentile":448.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"97","median_amount":333.0,"10th_percentile":302.43,"90th_percentile":666.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":116.56,"10th_percentile":89.31,"90th_percentile":762.27},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":743.87,"10th_percentile":743.87,"90th_percentile":743.87,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":333.0,"10th_percentile":333.0,"90th_percentile":333.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":326.34,"10th_percentile":326.34,"90th_percentile":326.34,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"56","median_amount":333.0,"10th_percentile":305.38,"90th_percentile":458.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":333.0,"10th_percentile":333.0,"90th_percentile":505.15,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"24","median_amount":333.0,"10th_percentile":333.0,"90th_percentile":544.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","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":370.06,"10th_percentile":370.06,"90th_percentile":370.06,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"23","median_amount":333.0,"10th_percentile":266.4,"90th_percentile":432.0,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"1 through 10","median_amount":333.0,"10th_percentile":333.0,"90th_percentile":333.0,"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":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"34","median_amount":305.38,"10th_percentile":275.0,"90th_percentile":403.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Extraocular, Repair, and Plastic Eye Procedures","code_information":[{"code":"5502","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"1 through 10","median_amount":1290.0,"10th_percentile":1290.0,"90th_percentile":12125.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":996.74,"10th_percentile":989.44,"90th_percentile":1294.82,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"1 through 10","median_amount":11224.0,"10th_percentile":11083.91,"90th_percentile":15207.01},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":671.37,"10th_percentile":671.37,"90th_percentile":671.37,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"14","median_amount":11154.77,"10th_percentile":7583.56,"90th_percentile":15238.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":405.3,"10th_percentile":405.3,"90th_percentile":405.3},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":474.94,"10th_percentile":474.94,"90th_percentile":474.94,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":714.59,"10th_percentile":714.59,"90th_percentile":714.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":954.53,"10th_percentile":954.53,"90th_percentile":954.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1594.56,"10th_percentile":1594.56,"90th_percentile":1594.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","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":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"1 through 10","median_amount":929.91,"10th_percentile":929.91,"90th_percentile":929.91,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":996.94,"10th_percentile":996.94,"90th_percentile":996.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Extraocular, Repair, and Plastic Eye Procedures","code_information":[{"code":"5503","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"16","median_amount":6009.66,"10th_percentile":3712.3,"90th_percentile":9293.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":3988.25,"10th_percentile":3829.65,"90th_percentile":3988.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"18","median_amount":2385.32,"10th_percentile":2163.75,"90th_percentile":2393.01,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2064.78,"10th_percentile":2064.78,"90th_percentile":2064.78,"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":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"1 through 10","median_amount":15791.45,"10th_percentile":10484.71,"90th_percentile":29597.46,"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":"BCBS","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"21","median_amount":12083.7,"10th_percentile":9140.79,"90th_percentile":20478.16},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":3589.42,"10th_percentile":1234.23,"90th_percentile":3988.89,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2393.01,"10th_percentile":2393.01,"90th_percentile":2393.01,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"74","median_amount":15346.6,"10th_percentile":10962.39,"90th_percentile":23580.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":5470.8,"10th_percentile":3295.29,"90th_percentile":7591.41},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2389.78,"10th_percentile":2389.78,"90th_percentile":2389.78,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2152.26,"10th_percentile":1660.86,"90th_percentile":3988.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2144.96,"10th_percentile":2144.96,"90th_percentile":2144.96,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"35","median_amount":2386.28,"10th_percentile":2236.28,"90th_percentile":2391.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"15","median_amount":3589.42,"10th_percentile":1660.86,"90th_percentile":3988.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2393.01,"10th_percentile":2393.01,"90th_percentile":2393.01,"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":"Molina Healthcare","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":3661.22,"10th_percentile":3661.22,"90th_percentile":3661.22,"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":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"27","median_amount":5891.0,"10th_percentile":4712.8,"90th_percentile":8836.5,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"1 through 10","median_amount":8678.75,"10th_percentile":8678.75,"90th_percentile":8678.75,"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":"[APC ($): FEE SCHEDULE]","count":"25","median_amount":2383.29,"10th_percentile":1906.63,"90th_percentile":2391.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":3988.89,"10th_percentile":3988.89,"90th_percentile":3988.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 4 Extraocular, Repair, and Plastic Eye Procedures","code_information":[{"code":"5504","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"1 through 10","median_amount":6093.45,"10th_percentile":6093.45,"90th_percentile":6093.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3852.35,"10th_percentile":3852.35,"90th_percentile":3859.35,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"1 through 10","median_amount":19809.32,"10th_percentile":19809.32,"90th_percentile":19809.32,"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":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"1 through 10","median_amount":21882.84,"10th_percentile":21882.84,"90th_percentile":21882.84},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"11","median_amount":19640.55,"10th_percentile":18166.58,"90th_percentile":26151.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":6165.64,"10th_percentile":6165.64,"90th_percentile":6165.64},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2553.1,"10th_percentile":2553.1,"90th_percentile":2553.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3785.35,"10th_percentile":3785.35,"90th_percentile":3785.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3790.7,"10th_percentile":3790.7,"90th_percentile":3790.7,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2553.1,"10th_percentile":2553.1,"90th_percentile":2553.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","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":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"1 through 10","median_amount":11051.32,"10th_percentile":11051.32,"90th_percentile":11051.32,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3852.86,"10th_percentile":3852.86,"90th_percentile":3852.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Imaging without Contrast","code_information":[{"code":"5521","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"6330","median_amount":299.3,"10th_percentile":137.38,"90th_percentile":634.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1621","median_amount":70.52,"10th_percentile":67.71,"90th_percentile":155.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"5028","median_amount":90.15,"10th_percentile":84.14,"90th_percentile":91.79,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"39","median_amount":132.19,"10th_percentile":71.96,"90th_percentile":231.45,"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":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"4287","median_amount":446.0,"10th_percentile":279.05,"90th_percentile":945.0,"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":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"2210","median_amount":25.0,"10th_percentile":20.0,"90th_percentile":394.84},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"11","median_amount":439.0,"10th_percentile":407.0,"90th_percentile":453.0,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"2140","median_amount":70.52,"10th_percentile":67.71,"90th_percentile":137.26,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"889","median_amount":89.95,"10th_percentile":85.41,"90th_percentile":92.24,"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":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"470","median_amount":122.44,"10th_percentile":83.65,"90th_percentile":336.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"33554","median_amount":446.0,"10th_percentile":277.0,"90th_percentile":944.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"3448","median_amount":158.55,"10th_percentile":112.84,"90th_percentile":330.75},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"184","median_amount":90.15,"10th_percentile":67.26,"90th_percentile":92.26,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":85.86,"10th_percentile":35.98,"90th_percentile":89.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1498","median_amount":70.52,"10th_percentile":67.71,"90th_percentile":176.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"115","median_amount":81.36,"10th_percentile":51.56,"90th_percentile":81.56,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"4064","median_amount":91.79,"10th_percentile":65.81,"90th_percentile":103.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"164","median_amount":203.01,"10th_percentile":88.51,"90th_percentile":347.34,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"19","median_amount":71.96,"10th_percentile":71.96,"90th_percentile":155.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"5131","median_amount":70.52,"10th_percentile":67.71,"90th_percentile":124.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"153","median_amount":71.96,"10th_percentile":67.71,"90th_percentile":230.1,"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":"Molina Healthcare","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":"437","median_amount":71.93,"10th_percentile":69.06,"90th_percentile":143.81,"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":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"6997","median_amount":439.0,"10th_percentile":133.1,"90th_percentile":581.0,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"746","median_amount":439.0,"10th_percentile":277.0,"90th_percentile":594.0,"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":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"3678","median_amount":90.23,"10th_percentile":65.46,"90th_percentile":91.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"57","median_amount":70.52,"10th_percentile":67.71,"90th_percentile":215.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 2 Imaging without Contrast","code_information":[{"code":"5522","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"8699","median_amount":506.62,"10th_percentile":177.36,"90th_percentile":888.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1876","median_amount":134.01,"10th_percentile":70.52,"90th_percentile":334.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"7519","median_amount":109.03,"10th_percentile":108.63,"90th_percentile":222.12,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"74","median_amount":109.08,"10th_percentile":47.88,"90th_percentile":217.56,"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":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"5989","median_amount":981.0,"10th_percentile":507.67,"90th_percentile":1576.0,"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":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"1716","median_amount":45.0,"10th_percentile":20.0,"90th_percentile":981.0},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"17","median_amount":1063.0,"10th_percentile":487.0,"90th_percentile":2267.12,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"2288","median_amount":131.78,"10th_percentile":70.52,"90th_percentile":334.81,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1209","median_amount":109.63,"10th_percentile":103.33,"90th_percentile":205.28,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"519","median_amount":115.54,"10th_percentile":101.03,"90th_percentile":208.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"43572","median_amount":981.0,"10th_percentile":490.0,"90th_percentile":1576.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"4565","median_amount":343.35,"10th_percentile":171.5,"90th_percentile":551.6},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"272","median_amount":109.08,"10th_percentile":98.83,"90th_percentile":222.12,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"15","median_amount":108.63,"10th_percentile":101.8,"90th_percentile":223.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1460","median_amount":131.78,"10th_percentile":68.51,"90th_percentile":334.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"256","median_amount":98.27,"10th_percentile":73.27,"90th_percentile":200.91,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"5960","median_amount":110.85,"10th_percentile":103.38,"90th_percentile":217.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"202","median_amount":168.7,"10th_percentile":122.2,"90th_percentile":349.95,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"11","median_amount":86.91,"10th_percentile":86.91,"90th_percentile":183.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"4712","median_amount":131.78,"10th_percentile":70.52,"90th_percentile":317.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"290","median_amount":109.08,"10th_percentile":103.33,"90th_percentile":214.36,"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 Healthcare","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":"413","median_amount":131.23,"10th_percentile":71.93,"90th_percentile":345.56,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"9274","median_amount":731.0,"10th_percentile":321.46,"90th_percentile":1012.0,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"1061","median_amount":668.0,"10th_percentile":467.6,"90th_percentile":926.0,"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":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"4616","median_amount":109.14,"10th_percentile":86.91,"90th_percentile":218.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"20","median_amount":70.52,"10th_percentile":67.71,"90th_percentile":205.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 3 Imaging without Contrast","code_information":[{"code":"5523","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"1499","median_amount":1844.71,"10th_percentile":403.15,"90th_percentile":2693.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"517","median_amount":303.01,"10th_percentile":189.65,"90th_percentile":381.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1609","median_amount":247.69,"10th_percentile":209.89,"90th_percentile":250.93,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"12","median_amount":247.94,"10th_percentile":181.51,"90th_percentile":380.13,"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":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"1176","median_amount":3609.0,"10th_percentile":1752.0,"90th_percentile":3961.83,"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":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"532","median_amount":200.0,"10th_percentile":30.0,"90th_percentile":1662.0},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":"657","median_amount":303.01,"10th_percentile":142.69,"90th_percentile":381.74,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"281","median_amount":246.93,"10th_percentile":229.52,"90th_percentile":257.93,"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":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"130","median_amount":229.64,"10th_percentile":229.64,"90th_percentile":330.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"7828","median_amount":3609.0,"10th_percentile":1801.0,"90th_percentile":3999.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"780","median_amount":1247.4,"10th_percentile":570.21,"90th_percentile":1417.57},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"59","median_amount":247.93,"10th_percentile":226.89,"90th_percentile":303.01,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":248.93,"10th_percentile":248.93,"90th_percentile":248.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"396","median_amount":290.91,"10th_percentile":153.72,"90th_percentile":359.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"41","median_amount":223.23,"10th_percentile":129.13,"90th_percentile":226.77,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1560","median_amount":247.83,"10th_percentile":101.16,"90th_percentile":303.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"61","median_amount":303.58,"10th_percentile":279.95,"90th_percentile":467.42,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":197.55,"10th_percentile":197.55,"90th_percentile":197.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1205","median_amount":303.01,"10th_percentile":182.08,"90th_percentile":381.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"97","median_amount":247.94,"10th_percentile":205.44,"90th_percentile":303.01,"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":"Molina Healthcare","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":"120","median_amount":296.73,"10th_percentile":128.96,"90th_percentile":389.37,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"1641","median_amount":2251.2,"10th_percentile":657.9,"90th_percentile":2814.0,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"153","median_amount":1882.55,"10th_percentile":691.6,"90th_percentile":2569.0,"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":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1228","median_amount":247.34,"10th_percentile":99.94,"90th_percentile":251.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":303.01,"10th_percentile":303.01,"90th_percentile":303.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 4 Imaging without Contrast","code_information":[{"code":"5524","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"1100","median_amount":2550.62,"10th_percentile":914.5,"90th_percentile":4164.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"304","median_amount":543.79,"10th_percentile":390.13,"90th_percentile":648.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1630","median_amount":562.13,"10th_percentile":520.6,"90th_percentile":809.57,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":534.64,"10th_percentile":408.66,"90th_percentile":976.25,"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":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"800","median_amount":3610.67,"10th_percentile":2772.62,"90th_percentile":5906.0,"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":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"83","median_amount":1634.0,"10th_percentile":25.0,"90th_percentile":6343.34},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"1 through 10","median_amount":5906.0,"10th_percentile":5906.0,"90th_percentile":5906.0,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"308","median_amount":528.26,"10th_percentile":326.91,"90th_percentile":751.93,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"277","median_amount":562.13,"10th_percentile":518.49,"90th_percentile":809.1,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"102","median_amount":520.92,"10th_percentile":520.92,"90th_percentile":822.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"5413","median_amount":3712.0,"10th_percentile":3251.35,"90th_percentile":5911.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"561","median_amount":1222.9,"10th_percentile":1031.24,"90th_percentile":2067.1},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"76","median_amount":571.33,"10th_percentile":436.14,"90th_percentile":813.6,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"178","median_amount":522.08,"10th_percentile":189.65,"90th_percentile":681.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"46","median_amount":504.61,"10th_percentile":479.61,"90th_percentile":506.01,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1550","median_amount":563.13,"10th_percentile":413.13,"90th_percentile":810.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"72","median_amount":794.18,"10th_percentile":551.17,"90th_percentile":1154.67,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"580","median_amount":543.79,"10th_percentile":326.91,"90th_percentile":751.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"73","median_amount":645.65,"10th_percentile":522.08,"90th_percentile":732.59,"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":"Molina Healthcare","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":"67","median_amount":532.52,"10th_percentile":247.62,"90th_percentile":582.08,"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":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"1230","median_amount":1254.0,"10th_percentile":828.76,"90th_percentile":2066.0,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"143","median_amount":1146.0,"10th_percentile":859.5,"90th_percentile":1888.0,"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":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1223","median_amount":563.13,"10th_percentile":448.11,"90th_percentile":808.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Imaging with Contrast","code_information":[{"code":"5571","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"495","median_amount":2130.2,"10th_percentile":296.91,"90th_percentile":4358.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"228","median_amount":381.74,"10th_percentile":366.5,"90th_percentile":546.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"727","median_amount":185.57,"10th_percentile":181.86,"90th_percentile":448.06,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"12","median_amount":355.6,"10th_percentile":145.48,"90th_percentile":379.98,"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":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"451","median_amount":3313.0,"10th_percentile":957.0,"90th_percentile":7912.0,"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":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"207","median_amount":250.0,"10th_percentile":30.0,"90th_percentile":7849.0},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":"149","median_amount":381.74,"10th_percentile":70.52,"90th_percentile":609.18,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"145","median_amount":357.65,"10th_percentile":172.68,"90th_percentile":450.51,"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":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"59","median_amount":169.13,"10th_percentile":160.59,"90th_percentile":943.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"2664","median_amount":3311.0,"10th_percentile":957.0,"90th_percentile":7875.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"284","median_amount":1097.25,"10th_percentile":334.95,"90th_percentile":2712.15},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"37","median_amount":185.57,"10th_percentile":40.0,"90th_percentile":456.9,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"110","median_amount":381.74,"10th_percentile":142.69,"90th_percentile":690.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"22","median_amount":204.06,"10th_percentile":163.67,"90th_percentile":405.06,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"762","median_amount":271.93,"10th_percentile":101.51,"90th_percentile":451.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"25","median_amount":381.05,"10th_percentile":347.39,"90th_percentile":468.27,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"301","median_amount":381.74,"10th_percentile":148.62,"90th_percentile":478.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"50","median_amount":355.6,"10th_percentile":173.38,"90th_percentile":387.24,"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 Healthcare","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":"26","median_amount":389.37,"10th_percentile":227.39,"90th_percentile":481.36,"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":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"610","median_amount":1689.0,"10th_percentile":581.0,"90th_percentile":1906.0,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"68","median_amount":1542.0,"10th_percentile":555.0,"90th_percentile":1741.0,"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":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"643","median_amount":218.04,"10th_percentile":172.68,"90th_percentile":449.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":274.63,"10th_percentile":274.63,"90th_percentile":274.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 2 Imaging with Contrast","code_information":[{"code":"5572","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"1322","median_amount":2279.61,"10th_percentile":595.65,"90th_percentile":3301.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"409","median_amount":511.24,"10th_percentile":381.74,"90th_percentile":674.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1638","median_amount":366.32,"10th_percentile":359.09,"90th_percentile":474.92,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":370.16,"10th_percentile":332.86,"90th_percentile":850.64,"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":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"1188","median_amount":4792.0,"10th_percentile":3286.44,"90th_percentile":7697.29,"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":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"701","median_amount":250.0,"10th_percentile":30.0,"90th_percentile":7045.04},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"1 through 10","median_amount":5044.95,"10th_percentile":5044.95,"90th_percentile":5044.95,"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":"BCBS","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":"340","median_amount":511.24,"10th_percentile":381.74,"90th_percentile":812.38,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"327","median_amount":365.13,"10th_percentile":340.83,"90th_percentile":435.66,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"112","median_amount":339.3,"10th_percentile":339.3,"90th_percentile":550.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"7372","median_amount":4792.0,"10th_percentile":3510.0,"90th_percentile":7316.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"723","median_amount":1642.2,"10th_percentile":954.8,"90th_percentile":2456.65},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"63","median_amount":370.33,"10th_percentile":95.33,"90th_percentile":603.77,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":364.83,"10th_percentile":364.83,"90th_percentile":364.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"243","median_amount":490.83,"10th_percentile":370.84,"90th_percentile":738.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"49","median_amount":332.35,"10th_percentile":132.35,"90th_percentile":497.02,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1695","median_amount":367.83,"10th_percentile":217.83,"90th_percentile":510.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"66","median_amount":503.91,"10th_percentile":375.89,"90th_percentile":863.56,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":291.86,"10th_percentile":291.86,"90th_percentile":366.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"737","median_amount":511.24,"10th_percentile":370.84,"90th_percentile":648.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"93","median_amount":366.32,"10th_percentile":366.32,"90th_percentile":698.61,"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":"Molina Healthcare","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":506.57,"10th_percentile":389.37,"90th_percentile":537.6,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"1552","median_amount":2574.2,"10th_percentile":1152.8,"90th_percentile":2814.0,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"187","median_amount":2055.2,"10th_percentile":1052.39,"90th_percentile":2569.0,"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":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1192","median_amount":366.33,"10th_percentile":217.84,"90th_percentile":510.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Imaging with Contrast","code_information":[{"code":"5573","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"1 through 10","median_amount":3535.64,"10th_percentile":3535.64,"90th_percentile":3535.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":809.57,"10th_percentile":807.1,"90th_percentile":1040.72,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"1 through 10","median_amount":7719.0,"10th_percentile":6459.38,"90th_percentile":12080.0,"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":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"1 through 10","median_amount":239.55,"10th_percentile":239.55,"90th_percentile":239.55},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":521.83,"10th_percentile":521.83,"90th_percentile":521.83,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":813.1,"10th_percentile":813.1,"90th_percentile":813.1,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"28","median_amount":6209.39,"10th_percentile":5625.39,"90th_percentile":8107.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":1491.7,"10th_percentile":1491.7,"90th_percentile":1491.7},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":769.16,"10th_percentile":769.16,"90th_percentile":769.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":752.51,"10th_percentile":752.51,"90th_percentile":810.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":769.15,"10th_percentile":769.15,"90th_percentile":769.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 Healthcare","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":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"1 through 10","median_amount":2814.0,"10th_percentile":1123.0,"90th_percentile":3010.0,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"1 through 10","median_amount":2747.0,"10th_percentile":2747.0,"90th_percentile":2747.0,"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":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":809.26,"10th_percentile":807.1,"90th_percentile":812.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Nuclear Medicine and Related Services","code_information":[{"code":"5591","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"56","median_amount":1912.59,"10th_percentile":670.21,"90th_percentile":4781.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"24","median_amount":461.46,"10th_percentile":443.03,"90th_percentile":652.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"76","median_amount":422.76,"10th_percentile":224.3,"90th_percentile":870.1,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":328.4,"10th_percentile":328.4,"90th_percentile":328.4,"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":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"60","median_amount":3510.0,"10th_percentile":2723.0,"90th_percentile":11359.0,"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":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"1 through 10","median_amount":300.0,"10th_percentile":40.0,"90th_percentile":528.0},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":461.46,"10th_percentile":443.03,"90th_percentile":652.33,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"12","median_amount":426.3,"10th_percentile":248.8,"90th_percentile":632.89,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":509.68,"10th_percentile":387.24,"90th_percentile":800.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"335","median_amount":3490.0,"10th_percentile":2678.4,"90th_percentile":11359.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"37","median_amount":1131.2,"10th_percentile":788.76,"90th_percentile":3979.15},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":535.11,"10th_percentile":428.21,"90th_percentile":889.11,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"14","median_amount":461.46,"10th_percentile":443.03,"90th_percentile":513.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"46","median_amount":424.2,"10th_percentile":229.2,"90th_percentile":819.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1045.25,"10th_percentile":977.58,"90th_percentile":1045.25,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"44","median_amount":461.46,"10th_percentile":443.03,"90th_percentile":626.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":421.98,"10th_percentile":421.98,"90th_percentile":1337.22,"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":"Molina Healthcare","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":470.69,"10th_percentile":451.89,"90th_percentile":665.38,"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":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"90","median_amount":2929.0,"10th_percentile":1986.0,"90th_percentile":5122.5,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"1 through 10","median_amount":3207.5,"10th_percentile":3136.5,"90th_percentile":4678.5,"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":"[APC ($): FEE SCHEDULE]","count":"69","median_amount":420.31,"10th_percentile":273.31,"90th_percentile":824.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Nuclear Medicine and Related Services","code_information":[{"code":"5592","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"47","median_amount":1911.61,"10th_percentile":913.76,"90th_percentile":3445.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"20","median_amount":461.46,"10th_percentile":461.46,"90th_percentile":2865.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"49","median_amount":561.39,"10th_percentile":363.68,"90th_percentile":653.63,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"44","median_amount":3562.0,"10th_percentile":2897.0,"90th_percentile":7138.0,"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":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"13","median_amount":45.0,"10th_percentile":23.49,"90th_percentile":6558.0},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":461.46,"10th_percentile":443.03,"90th_percentile":1985.74,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":559.68,"10th_percentile":517.79,"90th_percentile":649.63,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":520.49,"10th_percentile":520.49,"90th_percentile":520.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"238","median_amount":3235.72,"10th_percentile":2903.0,"90th_percentile":6558.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"19","median_amount":1042.65,"10th_percentile":792.75,"90th_percentile":2146.55},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":533.87,"10th_percentile":409.36,"90th_percentile":1034.89,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":461.46,"10th_percentile":443.03,"90th_percentile":1313.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2289.96,"10th_percentile":2289.96,"90th_percentile":2289.96,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"48","median_amount":559.68,"10th_percentile":199.29,"90th_percentile":656.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":550.72,"10th_percentile":550.72,"90th_percentile":1416.61,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":519.7,"10th_percentile":519.7,"90th_percentile":519.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"24","median_amount":461.46,"10th_percentile":453.33,"90th_percentile":2751.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":519.87,"10th_percentile":519.87,"90th_percentile":519.87,"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":"Molina Healthcare","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":470.69,"10th_percentile":470.69,"90th_percentile":2806.45,"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":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"56","median_amount":3122.0,"10th_percentile":1139.5,"90th_percentile":3433.5,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"1 through 10","median_amount":3122.0,"10th_percentile":2551.63,"90th_percentile":3372.0,"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":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"33","median_amount":560.08,"10th_percentile":389.68,"90th_percentile":1490.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Nuclear Medicine and Related Services","code_information":[{"code":"5593","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"145","median_amount":5417.95,"10th_percentile":2050.07,"90th_percentile":7167.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"65","median_amount":1313.4,"10th_percentile":1260.97,"90th_percentile":2766.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"392","median_amount":1347.44,"10th_percentile":1298.46,"90th_percentile":2497.9,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1291.49,"10th_percentile":1291.49,"90th_percentile":2815.03,"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":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"97","median_amount":10221.0,"10th_percentile":4708.0,"90th_percentile":13875.54,"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":"BCBS","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"32","median_amount":7263.97,"10th_percentile":30.0,"90th_percentile":35239.47},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":"44","median_amount":1313.4,"10th_percentile":1260.97,"90th_percentile":2458.17,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"71","median_amount":1345.52,"10th_percentile":1339.52,"90th_percentile":2693.9,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"31","median_amount":1249.4,"10th_percentile":1245.76,"90th_percentile":2505.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"667","median_amount":10221.0,"10th_percentile":5996.0,"90th_percentile":13818.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"77","median_amount":3015.6,"10th_percentile":1019.2,"90th_percentile":4274.75},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"17","median_amount":1349.94,"10th_percentile":1149.82,"90th_percentile":2751.28,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"30","median_amount":1105.26,"10th_percentile":1061.14,"90th_percentile":4155.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"14","median_amount":1212.06,"10th_percentile":1013.09,"90th_percentile":1717.2,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"451","median_amount":1343.42,"10th_percentile":1142.54,"90th_percentile":2237.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"17","median_amount":1321.95,"10th_percentile":1291.56,"90th_percentile":2677.71,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"79","median_amount":1313.4,"10th_percentile":1260.97,"90th_percentile":2085.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"29","median_amount":1313.4,"10th_percentile":1076.72,"90th_percentile":2058.04,"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 Healthcare","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":1127.37,"10th_percentile":1127.37,"90th_percentile":1714.59,"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":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"160","median_amount":4238.9,"10th_percentile":1987.75,"90th_percentile":5474.72,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"20","median_amount":3871.9,"10th_percentile":1672.42,"90th_percentile":5017.9,"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":"[APC ($): FEE SCHEDULE]","count":"335","median_amount":1344.53,"10th_percentile":1169.53,"90th_percentile":2156.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Nuclear Medicine and Related Services","code_information":[{"code":"5594","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"96","median_amount":3904.85,"10th_percentile":2432.74,"90th_percentile":9480.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"47","median_amount":1675.47,"10th_percentile":1608.59,"90th_percentile":1680.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"227","median_amount":1494.05,"10th_percentile":1470.34,"90th_percentile":6264.99,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1648.04,"10th_percentile":1648.04,"90th_percentile":1648.04,"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":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"95","median_amount":11448.0,"10th_percentile":10580.25,"90th_percentile":22594.0,"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":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"32","median_amount":250.0,"10th_percentile":30.0,"90th_percentile":11448.0},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":1675.47,"10th_percentile":1608.59,"90th_percentile":1714.15,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"60","median_amount":1496.05,"10th_percentile":1466.05,"90th_percentile":5033.64,"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":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"12","median_amount":1385.75,"10th_percentile":1385.75,"90th_percentile":3716.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"478","median_amount":11448.0,"10th_percentile":10615.0,"90th_percentile":22594.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"56","median_amount":3547.95,"10th_percentile":2838.36,"90th_percentile":6200.12},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"17","median_amount":1490.05,"10th_percentile":1220.55,"90th_percentile":5211.62,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"30","median_amount":1675.47,"10th_percentile":1613.87,"90th_percentile":1680.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1345.04,"10th_percentile":1345.04,"90th_percentile":5022.03,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"294","median_amount":1493.05,"10th_percentile":1323.34,"90th_percentile":5541.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2016.83,"10th_percentile":1654.05,"90th_percentile":6812.45,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"74","median_amount":1680.97,"10th_percentile":1613.87,"90th_percentile":1680.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"12","median_amount":1496.13,"10th_percentile":1496.13,"90th_percentile":1496.13,"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 Healthcare","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":1708.98,"10th_percentile":1665.63,"90th_percentile":1714.59,"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":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"157","median_amount":4543.0,"10th_percentile":3161.32,"90th_percentile":8793.9,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"17","median_amount":4151.0,"10th_percentile":4151.0,"90th_percentile":12510.65,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"157","median_amount":1493.06,"10th_percentile":1338.05,"90th_percentile":4364.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Therapeutic Radiation Treatment Preparation","code_information":[{"code":"5611","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"1 through 10","median_amount":819.79,"10th_percentile":819.79,"90th_percentile":819.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":150.87,"10th_percentile":150.87,"90th_percentile":150.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7945.02,"10th_percentile":7945.02,"90th_percentile":7945.02,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":126.14,"10th_percentile":126.14,"90th_percentile":126.14,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"1 through 10","median_amount":1123.0,"10th_percentile":1059.84,"90th_percentile":3694.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":20615.71,"10th_percentile":20615.71,"90th_percentile":20615.71},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":122.57,"10th_percentile":122.57,"90th_percentile":122.57,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":267.84,"10th_percentile":109.04,"90th_percentile":267.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":17155.38,"10th_percentile":17155.38,"90th_percentile":17155.38,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","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":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"1 through 10","median_amount":3640.0,"10th_percentile":3640.0,"90th_percentile":3640.0,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Therapeutic Radiation Treatment Preparation","code_information":[{"code":"5612","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"22","median_amount":5599.78,"10th_percentile":2024.45,"90th_percentile":25295.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"12","median_amount":577.61,"10th_percentile":351.3,"90th_percentile":2102.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"31","median_amount":750.99,"10th_percentile":373.97,"90th_percentile":4881.08,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":8363.26,"10th_percentile":8363.26,"90th_percentile":8363.26,"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":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"31","median_amount":6715.0,"10th_percentile":2954.0,"90th_percentile":28060.0,"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":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"1 through 10","median_amount":48332.0,"10th_percentile":48332.0,"90th_percentile":48557.0},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":369.7,"10th_percentile":234.2,"90th_percentile":619.27,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":510.5,"10th_percentile":464.0,"90th_percentile":5863.94,"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":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"88","median_amount":8406.65,"10th_percentile":4077.0,"90th_percentile":48557.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"17","median_amount":5154.1,"10th_percentile":1491.7,"90th_percentile":19629.4},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":750.98,"10th_percentile":750.98,"90th_percentile":750.98,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":369.7,"10th_percentile":234.2,"90th_percentile":8513.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":337.94,"10th_percentile":337.94,"90th_percentile":337.94,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"44","median_amount":1118.81,"10th_percentile":511.68,"90th_percentile":6805.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5628.48,"10th_percentile":5628.48,"90th_percentile":9786.83,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"16","median_amount":385.07,"10th_percentile":227.51,"90th_percentile":8513.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":897.52,"10th_percentile":654.77,"90th_percentile":5130.84,"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 Healthcare","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":512.21,"10th_percentile":512.21,"90th_percentile":512.21,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"31","median_amount":3784.9,"10th_percentile":1106.64,"90th_percentile":25220.3,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"1 through 10","median_amount":29910.67,"10th_percentile":29910.67,"90th_percentile":29910.67,"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":"[APC ($): FEE SCHEDULE]","count":"31","median_amount":3423.59,"10th_percentile":407.69,"90th_percentile":7731.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Therapeutic Radiation Treatment Preparation","code_information":[{"code":"5613","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"20","median_amount":14210.91,"10th_percentile":4778.08,"90th_percentile":23035.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2812.56,"10th_percentile":2223.81,"90th_percentile":3504.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"25","median_amount":3224.9,"10th_percentile":2655.68,"90th_percentile":3973.49,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"24","median_amount":22407.0,"10th_percentile":18211.02,"90th_percentile":29006.0,"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":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"1 through 10","median_amount":21126.0,"10th_percentile":21126.0,"90th_percentile":43237.0},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":1838.74,"10th_percentile":1687.87,"90th_percentile":3612.5,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2961.3,"10th_percentile":2416.97,"90th_percentile":4037.83,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2847.85,"10th_percentile":2847.85,"90th_percentile":2847.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"81","median_amount":21513.0,"10th_percentile":18366.0,"90th_percentile":28789.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"15","median_amount":8384.95,"10th_percentile":5462.1,"90th_percentile":10152.1},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2160.31,"10th_percentile":2135.05,"90th_percentile":2778.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"33","median_amount":3052.6,"10th_percentile":1933.57,"90th_percentile":5186.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3101.88,"10th_percentile":3101.88,"90th_percentile":3101.88,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"13","median_amount":2135.05,"10th_percentile":1786.24,"90th_percentile":3420.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2260.43,"10th_percentile":2260.43,"90th_percentile":2260.43,"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":"Molina Healthcare","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":2715.83,"10th_percentile":2715.83,"90th_percentile":2715.83,"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":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"19","median_amount":17419.5,"10th_percentile":5084.14,"90th_percentile":20430.2,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"1 through 10","median_amount":14956.91,"10th_percentile":14956.91,"90th_percentile":14956.91,"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":"[APC ($): FEE SCHEDULE]","count":"24","median_amount":2927.4,"10th_percentile":2187.55,"90th_percentile":3868.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Radiation Therapy","code_information":[{"code":"5622","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"59","median_amount":9496.38,"10th_percentile":1858.58,"90th_percentile":13486.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"27","median_amount":3465.56,"10th_percentile":1953.11,"90th_percentile":4494.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"66","median_amount":2379.51,"10th_percentile":805.98,"90th_percentile":4499.65,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"57","median_amount":17003.0,"10th_percentile":3944.0,"90th_percentile":32611.0,"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":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"1 through 10","median_amount":8138.17,"10th_percentile":996.97,"90th_percentile":8923.74},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":2787.64,"10th_percentile":805.14,"90th_percentile":4072.45,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"11","median_amount":1750.19,"10th_percentile":945.53,"90th_percentile":5347.11,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2503.36,"10th_percentile":1751.38,"90th_percentile":4640.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"258","median_amount":16577.0,"10th_percentile":4342.0,"90th_percentile":27605.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"41","median_amount":6247.15,"10th_percentile":2583.94,"90th_percentile":8970.89},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3226.52,"10th_percentile":2824.83,"90th_percentile":4837.51,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"14","median_amount":3399.23,"10th_percentile":1205.48,"90th_percentile":4439.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"81","median_amount":2700.13,"10th_percentile":942.38,"90th_percentile":4552.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3333.37,"10th_percentile":1406.97,"90th_percentile":4151.36,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"36","median_amount":2506.23,"10th_percentile":795.73,"90th_percentile":3921.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2602.55,"10th_percentile":2602.55,"90th_percentile":3106.07,"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":"Molina Healthcare","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":2050.53,"10th_percentile":170.54,"90th_percentile":3773.81,"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":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"66","median_amount":9259.6,"10th_percentile":1830.04,"90th_percentile":22082.2,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"1 through 10","median_amount":13437.67,"10th_percentile":6555.9,"90th_percentile":30327.66,"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":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"62","median_amount":2420.56,"10th_percentile":811.9,"90th_percentile":4402.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Radiation Therapy","code_information":[{"code":"5623","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"13","median_amount":25254.35,"10th_percentile":9214.88,"90th_percentile":31708.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"11","median_amount":6060.22,"10th_percentile":3863.7,"90th_percentile":7124.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"31","median_amount":5234.31,"10th_percentile":2431.56,"90th_percentile":7362.66,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"15","median_amount":37112.0,"10th_percentile":6222.34,"90th_percentile":47550.0,"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":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":"32","median_amount":5989.3,"10th_percentile":2994.65,"90th_percentile":7128.83,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6771.71,"10th_percentile":4998.86,"90th_percentile":8824.61,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5873.19,"10th_percentile":4099.34,"90th_percentile":6297.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"84","median_amount":35641.0,"10th_percentile":21262.0,"90th_percentile":48698.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"12","median_amount":10462.9,"10th_percentile":4657.8,"90th_percentile":17044.3},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6799.34,"10th_percentile":6799.34,"90th_percentile":7067.11,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":5644.68,"10th_percentile":5419.34,"90th_percentile":7894.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5585.44,"10th_percentile":5585.44,"90th_percentile":6775.04,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"70","median_amount":5725.64,"10th_percentile":2635.06,"90th_percentile":6907.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"18","median_amount":5989.3,"10th_percentile":3564.61,"90th_percentile":7498.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"12","median_amount":408.57,"10th_percentile":178.5,"90th_percentile":5476.43,"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":"Molina Healthcare","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":3335.43,"10th_percentile":605.53,"90th_percentile":5603.66,"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":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"26","median_amount":25257.4,"10th_percentile":3683.4,"90th_percentile":34274.1,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"1 through 10","median_amount":19826.81,"10th_percentile":14922.75,"90th_percentile":20980.85,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"35","median_amount":6040.81,"10th_percentile":2048.93,"90th_percentile":7487.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Radiation Therapy","code_information":[{"code":"5624","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"1 through 10","median_amount":16627.38,"10th_percentile":9691.0,"90th_percentile":16851.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3118.03,"10th_percentile":1355.07,"90th_percentile":4514.8,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"1 through 10","median_amount":27261.0,"10th_percentile":27261.0,"90th_percentile":34281.17},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":4285.43,"10th_percentile":4285.43,"90th_percentile":4285.43,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4530.93,"10th_percentile":4530.93,"90th_percentile":4530.93,"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":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"1 through 10","median_amount":28906.0,"10th_percentile":15027.0,"90th_percentile":35005.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1063.78,"10th_percentile":1063.78,"90th_percentile":3099.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4220.8,"10th_percentile":1614.96,"90th_percentile":4528.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","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":3109.41,"10th_percentile":3109.41,"90th_percentile":3109.41,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"1 through 10","median_amount":786.0,"10th_percentile":786.0,"90th_percentile":786.0,"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":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3246.17,"10th_percentile":3246.17,"90th_percentile":3404.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 6 Radiation Therapy","code_information":[{"code":"5626","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":7297.91,"10th_percentile":3976.8,"90th_percentile":8825.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6734.52,"10th_percentile":6004.55,"90th_percentile":9104.58,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"1 through 10","median_amount":83527.0,"10th_percentile":83527.0,"90th_percentile":89127.0,"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":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6326.12,"10th_percentile":6326.12,"90th_percentile":7340.72,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"1 through 10","median_amount":82109.0,"10th_percentile":29320.0,"90th_percentile":86342.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":9863.39,"10th_percentile":9863.39,"90th_percentile":12649.73,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6709.2,"10th_percentile":6709.2,"90th_percentile":6709.2,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7148.22,"10th_percentile":5517.0,"90th_percentile":11182.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":7147.04,"10th_percentile":7147.04,"90th_percentile":7147.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","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":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"1 through 10","median_amount":45496.5,"10th_percentile":45496.5,"90th_percentile":45496.5,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7148.67,"10th_percentile":5521.84,"90th_percentile":7483.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Therapeutic Nuclear Medicine","code_information":[{"code":"5661","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"1 through 10","median_amount":8814.11,"10th_percentile":8814.11,"90th_percentile":8814.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":842.93,"10th_percentile":842.93,"90th_percentile":842.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":47543.76,"10th_percentile":228.97,"90th_percentile":51877.74,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"1 through 10","median_amount":4635.0,"10th_percentile":4635.0,"90th_percentile":16704.0,"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":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"12","median_amount":16217.0,"10th_percentile":4507.0,"90th_percentile":166259.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":481.56,"10th_percentile":481.56,"90th_percentile":481.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":47516.86,"10th_percentile":2500.8,"90th_percentile":49855.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":842.93,"10th_percentile":842.93,"90th_percentile":842.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","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":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"1 through 10","median_amount":6783.0,"10th_percentile":6783.0,"90th_percentile":6783.0,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"1 through 10","median_amount":2365.61,"10th_percentile":1366.0,"90th_percentile":84312.0,"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":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":51376.31,"10th_percentile":51376.31,"90th_percentile":51376.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Pathology","code_information":[{"code":"5671","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"937","median_amount":208.0,"10th_percentile":89.12,"90th_percentile":429.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"183","median_amount":40.49,"10th_percentile":38.87,"90th_percentile":76.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"822","median_amount":54.59,"10th_percentile":54.59,"90th_percentile":54.69,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":46.54,"10th_percentile":46.54,"90th_percentile":46.54,"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":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"644","median_amount":484.0,"10th_percentile":318.0,"90th_percentile":1212.67,"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":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"465","median_amount":35.73,"10th_percentile":20.0,"90th_percentile":243.71},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":"238","median_amount":40.49,"10th_percentile":38.87,"90th_percentile":94.39,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"135","median_amount":54.59,"10th_percentile":49.69,"90th_percentile":54.69,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"14","median_amount":50.76,"10th_percentile":50.76,"90th_percentile":5026.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"4066","median_amount":484.0,"10th_percentile":318.0,"90th_percentile":1075.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"431","median_amount":169.4,"10th_percentile":121.1,"90th_percentile":449.48},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"31","median_amount":54.59,"10th_percentile":50.93,"90th_percentile":108.83,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"188","median_amount":40.49,"10th_percentile":38.87,"90th_percentile":60.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"23","median_amount":49.13,"10th_percentile":49.13,"90th_percentile":49.13,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"756","median_amount":54.59,"10th_percentile":54.59,"90th_percentile":54.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":67.14,"10th_percentile":67.14,"90th_percentile":134.28,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":54.59,"10th_percentile":54.59,"90th_percentile":54.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"339","median_amount":40.49,"10th_percentile":38.87,"90th_percentile":100.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"13","median_amount":54.59,"10th_percentile":43.67,"90th_percentile":69.13,"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 Healthcare","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":41.3,"10th_percentile":39.65,"90th_percentile":130.34,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"953","median_amount":217.0,"10th_percentile":80.77,"90th_percentile":217.0,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"105","median_amount":199.0,"10th_percentile":191.0,"90th_percentile":398.0,"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":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"502","median_amount":54.59,"10th_percentile":54.59,"90th_percentile":54.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":60.74,"10th_percentile":60.74,"90th_percentile":60.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 2 Pathology","code_information":[{"code":"5672","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"45","median_amount":582.05,"10th_percentile":285.81,"90th_percentile":7757.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"16","median_amount":225.95,"10th_percentile":174.04,"90th_percentile":375.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"37","median_amount":175.06,"10th_percentile":175.06,"90th_percentile":1944.91,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"42","median_amount":1337.0,"10th_percentile":516.67,"90th_percentile":3306.0,"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":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"16","median_amount":100.0,"10th_percentile":40.0,"90th_percentile":23313.61},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"1 through 10","median_amount":1704.0,"10th_percentile":1704.0,"90th_percentile":1704.0,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":216.93,"10th_percentile":197.49,"90th_percentile":298.18,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"11","median_amount":175.06,"10th_percentile":160.62,"90th_percentile":1739.35,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":162.81,"10th_percentile":162.81,"90th_percentile":1657.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"171","median_amount":1455.0,"10th_percentile":552.0,"90th_percentile":17494.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"20","median_amount":509.25,"10th_percentile":198.8,"90th_percentile":2718.8},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":178.56,"10th_percentile":178.56,"90th_percentile":178.56,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":175.06,"10th_percentile":175.06,"90th_percentile":175.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"25","median_amount":205.7,"10th_percentile":163.72,"90th_percentile":292.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":157.55,"10th_percentile":157.55,"90th_percentile":157.55,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"61","median_amount":175.06,"10th_percentile":175.06,"90th_percentile":3036.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"31","median_amount":205.7,"10th_percentile":175.79,"90th_percentile":270.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":175.77,"10th_percentile":175.06,"90th_percentile":5360.14,"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":"Molina Healthcare","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":209.81,"10th_percentile":209.81,"90th_percentile":3186.16,"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":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"38","median_amount":217.0,"10th_percentile":173.6,"90th_percentile":3651.57,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"1 through 10","median_amount":199.0,"10th_percentile":199.0,"90th_percentile":9479.0,"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":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"26","median_amount":175.06,"10th_percentile":175.06,"90th_percentile":1945.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Pathology","code_information":[{"code":"5673","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"149","median_amount":514.97,"10th_percentile":264.45,"90th_percentile":12493.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"21","median_amount":288.31,"10th_percentile":199.83,"90th_percentile":8571.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"88","median_amount":367.48,"10th_percentile":362.58,"90th_percentile":7564.37,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7329.71,"10th_percentile":7329.71,"90th_percentile":7329.71,"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":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"106","median_amount":1370.0,"10th_percentile":602.97,"90th_percentile":65112.87,"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":"BCBS","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"106","median_amount":147.42,"10th_percentile":20.0,"90th_percentile":75229.78},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":205.7,"10th_percentile":205.7,"90th_percentile":407.6,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"14","median_amount":367.58,"10th_percentile":367.48,"90th_percentile":372.58,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":333.2,"10th_percentile":333.2,"90th_percentile":5912.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"646","median_amount":811.0,"10th_percentile":652.0,"90th_percentile":56755.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"60","median_amount":409.15,"10th_percentile":233.45,"90th_percentile":17599.48},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":367.48,"10th_percentile":367.48,"90th_percentile":8373.96,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"25","median_amount":276.8,"10th_percentile":197.49,"90th_percentile":8602.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":330.73,"10th_percentile":330.73,"90th_percentile":12444.06,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"99","median_amount":367.48,"10th_percentile":367.48,"90th_percentile":7141.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":616.97,"10th_percentile":452.01,"90th_percentile":616.97,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"63","median_amount":219.0,"10th_percentile":197.49,"90th_percentile":4656.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":293.98,"10th_percentile":293.98,"90th_percentile":367.48,"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":"Molina Healthcare","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":209.81,"10th_percentile":207.65,"90th_percentile":2596.3,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"128","median_amount":217.0,"10th_percentile":207.0,"90th_percentile":13046.0,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"19","median_amount":205.7,"10th_percentile":199.0,"90th_percentile":12112.5,"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":"[APC ($): FEE SCHEDULE]","count":"48","median_amount":367.49,"10th_percentile":337.83,"90th_percentile":3528.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Pathology","code_information":[{"code":"5674","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"15","median_amount":18634.25,"10th_percentile":15962.0,"90th_percentile":38424.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":9173.8,"10th_percentile":9173.8,"90th_percentile":9173.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"14","median_amount":10637.53,"10th_percentile":9536.94,"90th_percentile":11012.48,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":9263.33,"10th_percentile":9263.33,"90th_percentile":9263.33,"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":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"14","median_amount":75532.0,"10th_percentile":69058.35,"90th_percentile":98538.5,"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":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"25","median_amount":76019.2,"10th_percentile":60087.78,"90th_percentile":91092.14},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":9443.44,"10th_percentile":51.53,"90th_percentile":14296.84,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":10713.06,"10th_percentile":1578.86,"90th_percentile":13622.56,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":12650.96,"10th_percentile":12650.96,"90th_percentile":12650.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"64","median_amount":72262.05,"10th_percentile":59837.4,"90th_percentile":85479.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":27014.06,"10th_percentile":21387.88,"90th_percentile":28567.99},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":10357.84,"10th_percentile":10357.84,"90th_percentile":10357.84,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":976.25,"10th_percentile":23.49,"90th_percentile":9245.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"28","median_amount":11009.23,"10th_percentile":9694.21,"90th_percentile":13686.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":10467.09,"10th_percentile":10467.09,"90th_percentile":10467.09,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":7042.42,"10th_percentile":7042.42,"90th_percentile":9443.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":9479.87,"10th_percentile":9479.87,"90th_percentile":9479.87,"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":"Molina Healthcare","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":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"18","median_amount":18937.96,"10th_percentile":12239.51,"90th_percentile":33971.0,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"1 through 10","median_amount":28930.12,"10th_percentile":17972.25,"90th_percentile":31077.77,"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":"[APC ($): FEE SCHEDULE]","count":"14","median_amount":11011.93,"10th_percentile":10635.81,"90th_percentile":13200.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Drug Administration","code_information":[{"code":"5691","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"1 through 10","median_amount":4422.6,"10th_percentile":2657.75,"90th_percentile":9927.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2028.2,"10th_percentile":2028.2,"90th_percentile":2028.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2704.85,"10th_percentile":149.75,"90th_percentile":2803.37,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":327.43,"10th_percentile":143.34,"90th_percentile":355.03,"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":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"1 through 10","median_amount":23611.26,"10th_percentile":19843.17,"90th_percentile":29021.29,"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":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"11","median_amount":24425.34,"10th_percentile":8780.96,"90th_percentile":35895.79},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":1112.74,"10th_percentile":254.0,"90th_percentile":3721.71,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":267.0,"10th_percentile":267.0,"90th_percentile":267.0,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"73","median_amount":56.04,"10th_percentile":41.52,"90th_percentile":204.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"33","median_amount":15692.87,"10th_percentile":6751.17,"90th_percentile":34236.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":2975.94,"10th_percentile":2552.49,"90th_percentile":8100.99},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1968.07,"10th_percentile":1968.07,"90th_percentile":1968.07,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":3986.35,"10th_percentile":1364.78,"90th_percentile":5277.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":79.41,"10th_percentile":79.41,"90th_percentile":79.41,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1773.49,"10th_percentile":108.54,"90th_percentile":2842.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"39","median_amount":171.36,"10th_percentile":100.38,"90th_percentile":313.69,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1676.78,"10th_percentile":330.21,"90th_percentile":3722.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"48","median_amount":113.34,"10th_percentile":76.62,"90th_percentile":288.4,"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":"Molina Healthcare","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":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"1 through 10","median_amount":3167.13,"10th_percentile":1945.8,"90th_percentile":4356.0,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2620.95,"10th_percentile":1722.43,"90th_percentile":2707.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Drug Administration","code_information":[{"code":"5692","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"46","median_amount":386.21,"10th_percentile":70.0,"90th_percentile":4604.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"29","median_amount":58.17,"10th_percentile":55.84,"90th_percentile":551.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"50","median_amount":73.0,"10th_percentile":68.81,"90th_percentile":1135.77,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"25","median_amount":192.63,"10th_percentile":58.16,"90th_percentile":300.26,"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":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"39","median_amount":96.0,"10th_percentile":78.12,"90th_percentile":4409.87,"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":"BCBS","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"27","median_amount":2717.33,"10th_percentile":40.0,"90th_percentile":19773.36},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":260.53,"10th_percentile":192.09,"90th_percentile":568.21,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":292.86,"10th_percentile":292.86,"90th_percentile":292.86,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"87","median_amount":185.1,"10th_percentile":69.0,"90th_percentile":265.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"187","median_amount":1191.93,"10th_percentile":96.0,"90th_percentile":13924.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"13","median_amount":425.83,"10th_percentile":49.35,"90th_percentile":4983.5},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":240.42,"10th_percentile":240.42,"90th_percentile":240.42,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"22","median_amount":240.42,"10th_percentile":26.69,"90th_percentile":350.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":799.35,"10th_percentile":799.35,"90th_percentile":799.35,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"21","median_amount":471.99,"10th_percentile":70.0,"90th_percentile":1110.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"27","median_amount":248.71,"10th_percentile":127.88,"90th_percentile":752.15,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"59","median_amount":176.02,"10th_percentile":31.05,"90th_percentile":1940.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"72","median_amount":139.33,"10th_percentile":13.12,"90th_percentile":198.38,"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":"Molina Healthcare","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":56.96,"10th_percentile":56.96,"90th_percentile":56.96,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"21","median_amount":153.55,"10th_percentile":72.8,"90th_percentile":1513.0,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"1 through 10","median_amount":1382.0,"10th_percentile":471.87,"90th_percentile":5732.96,"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":"[APC ($): FEE SCHEDULE]","count":"31","median_amount":70.0,"10th_percentile":65.0,"90th_percentile":1090.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Drug Administration","code_information":[{"code":"5693","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"62","median_amount":2170.91,"10th_percentile":873.78,"90th_percentile":3971.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"46","median_amount":663.04,"10th_percentile":369.92,"90th_percentile":1206.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"48","median_amount":879.97,"10th_percentile":352.11,"90th_percentile":1180.54,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":487.64,"10th_percentile":487.64,"90th_percentile":487.64,"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":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"54","median_amount":3653.61,"10th_percentile":1816.21,"90th_percentile":6864.63,"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":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"96","median_amount":4640.26,"10th_percentile":2108.18,"90th_percentile":7887.56},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":243.04,"10th_percentile":243.04,"90th_percentile":922.44,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":812.55,"10th_percentile":556.32,"90th_percentile":2572.55,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2566.85,"10th_percentile":830.72,"90th_percentile":2567.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"382","median_amount":3710.5,"10th_percentile":1506.0,"90th_percentile":6677.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"38","median_amount":1159.87,"10th_percentile":378.8,"90th_percentile":2555.74},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":924.3,"10th_percentile":924.3,"90th_percentile":924.3,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"38","median_amount":690.96,"10th_percentile":243.04,"90th_percentile":1267.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":657.76,"10th_percentile":657.76,"90th_percentile":657.76,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"44","median_amount":730.85,"10th_percentile":445.0,"90th_percentile":2713.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":870.09,"10th_percentile":545.25,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":849.77,"10th_percentile":849.77,"90th_percentile":849.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"160","median_amount":491.44,"10th_percentile":307.38,"90th_percentile":1221.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":969.45,"10th_percentile":215.24,"90th_percentile":2164.15,"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":"Molina Healthcare","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":567.5,"10th_percentile":362.26,"90th_percentile":1362.48,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"96","median_amount":1263.43,"10th_percentile":864.0,"90th_percentile":2791.38,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"1 through 10","median_amount":1179.0,"10th_percentile":950.0,"90th_percentile":3978.0,"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":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"56","median_amount":842.91,"10th_percentile":377.02,"90th_percentile":2705.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1539.29,"10th_percentile":1539.29,"90th_percentile":1539.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 4 Drug Administration","code_information":[{"code":"5694","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"55","median_amount":422.1,"10th_percentile":171.63,"90th_percentile":1511.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"93","median_amount":1793.97,"10th_percentile":362.8,"90th_percentile":2016.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"160","median_amount":1127.33,"10th_percentile":332.01,"90th_percentile":2389.23,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":409.38,"10th_percentile":346.13,"90th_percentile":1983.92,"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":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"17","median_amount":4995.33,"10th_percentile":412.06,"90th_percentile":5555.0,"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":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"11","median_amount":35.1,"10th_percentile":20.0,"90th_percentile":50.0},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":"68","median_amount":447.0,"10th_percentile":348.32,"90th_percentile":1946.29,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"51","median_amount":356.8,"10th_percentile":338.84,"90th_percentile":1851.1,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"25","median_amount":358.11,"10th_percentile":332.03,"90th_percentile":634.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"173","median_amount":517.0,"10th_percentile":387.0,"90th_percentile":5607.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"35","median_amount":165.31,"10th_percentile":135.73,"90th_percentile":1962.45},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"23","median_amount":362.8,"10th_percentile":60.68,"90th_percentile":2082.01,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"35","median_amount":433.05,"10th_percentile":348.32,"90th_percentile":1936.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"14","median_amount":2537.32,"10th_percentile":391.14,"90th_percentile":5122.62,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"255","median_amount":586.67,"10th_percentile":353.08,"90th_percentile":2780.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"18","median_amount":451.98,"10th_percentile":333.42,"90th_percentile":2910.36,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"92","median_amount":433.05,"10th_percentile":348.32,"90th_percentile":2016.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1606.52,"10th_percentile":16.14,"90th_percentile":4010.8,"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 Healthcare","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":441.72,"10th_percentile":237.51,"90th_percentile":457.0,"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":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"65","median_amount":447.0,"10th_percentile":72.0,"90th_percentile":3921.6,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"176","median_amount":1527.16,"10th_percentile":338.85,"90th_percentile":2366.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Diagnostic Tests and Related Services","code_information":[{"code":"5721","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"252","median_amount":490.0,"10th_percentile":245.96,"90th_percentile":905.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"54","median_amount":190.64,"10th_percentile":183.03,"90th_percentile":278.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"180","median_amount":160.34,"10th_percentile":158.58,"90th_percentile":161.84,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":145.23,"10th_percentile":127.86,"90th_percentile":266.47,"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":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"186","median_amount":1241.0,"10th_percentile":1040.16,"90th_percentile":1358.0,"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":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"1 through 10","median_amount":233.18,"10th_percentile":160.0,"90th_percentile":1358.0},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":190.64,"10th_percentile":183.03,"90th_percentile":331.61,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"33","median_amount":161.84,"10th_percentile":159.84,"90th_percentile":213.37,"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":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"68","median_amount":151.68,"10th_percentile":122.44,"90th_percentile":249.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"1341","median_amount":1241.0,"10th_percentile":1127.33,"90th_percentile":1358.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"145","median_amount":434.35,"10th_percentile":380.24,"90th_percentile":475.3},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":163.1,"10th_percentile":159.84,"90th_percentile":190.64,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"43","median_amount":190.64,"10th_percentile":183.03,"90th_percentile":199.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":145.75,"10th_percentile":144.35,"90th_percentile":190.64,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"167","median_amount":159.84,"10th_percentile":147.2,"90th_percentile":160.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"33","median_amount":196.0,"10th_percentile":130.68,"90th_percentile":282.07,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":63.94,"10th_percentile":63.94,"90th_percentile":160.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"102","median_amount":190.64,"10th_percentile":183.03,"90th_percentile":208.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"40","median_amount":127.87,"10th_percentile":100.28,"90th_percentile":254.5,"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 Healthcare","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":194.45,"10th_percentile":188.9,"90th_percentile":194.45,"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":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"279","median_amount":1241.0,"10th_percentile":642.0,"90th_percentile":1284.0,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"29","median_amount":1172.0,"10th_percentile":850.83,"90th_percentile":1172.0,"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":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"116","median_amount":160.34,"10th_percentile":110.84,"90th_percentile":162.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Diagnostic Tests and Related Services","code_information":[{"code":"5722","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"411","median_amount":803.0,"10th_percentile":306.6,"90th_percentile":1927.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"139","median_amount":259.09,"10th_percentile":208.14,"90th_percentile":540.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"497","median_amount":318.12,"10th_percentile":295.0,"90th_percentile":320.12,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":254.5,"10th_percentile":254.5,"90th_percentile":297.2,"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":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"300","median_amount":1581.0,"10th_percentile":420.0,"90th_percentile":2641.0,"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":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"11","median_amount":25.0,"10th_percentile":18.52,"90th_percentile":45.0},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"1 through 10","median_amount":2641.0,"10th_percentile":2641.0,"90th_percentile":2641.0,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"154","median_amount":249.71,"10th_percentile":208.14,"90th_percentile":433.05,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"87","median_amount":318.12,"10th_percentile":225.4,"90th_percentile":320.12,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"37","median_amount":301.89,"10th_percentile":166.47,"90th_percentile":424.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"1804","median_amount":1709.0,"10th_percentile":420.0,"90th_percentile":2641.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"214","median_amount":598.15,"10th_percentile":147.0,"90th_percentile":924.35},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"18","median_amount":318.12,"10th_percentile":243.4,"90th_percentile":429.17,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"113","median_amount":249.71,"10th_percentile":199.83,"90th_percentile":540.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"16","median_amount":286.81,"10th_percentile":261.81,"90th_percentile":288.21,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"395","median_amount":318.12,"10th_percentile":278.92,"90th_percentile":319.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"19","median_amount":391.28,"10th_percentile":391.28,"90th_percentile":491.47,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":254.5,"10th_percentile":254.5,"90th_percentile":254.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"251","median_amount":256.07,"10th_percentile":208.14,"90th_percentile":420.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"30","median_amount":266.72,"10th_percentile":254.5,"90th_percentile":319.42,"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":"Molina Healthcare","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":420.0,"10th_percentile":254.7,"90th_percentile":574.08,"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":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"411","median_amount":654.3,"10th_percentile":351.0,"90th_percentile":812.0,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"48","median_amount":540.0,"10th_percentile":420.0,"90th_percentile":1677.0,"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":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"325","median_amount":318.52,"10th_percentile":254.5,"90th_percentile":319.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":266.72,"10th_percentile":266.72,"90th_percentile":266.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 3 Diagnostic Tests and Related Services","code_information":[{"code":"5723","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"147","median_amount":1082.59,"10th_percentile":619.49,"90th_percentile":2449.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"70","median_amount":249.71,"10th_percentile":239.74,"90th_percentile":740.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"171","median_amount":543.71,"10th_percentile":496.29,"90th_percentile":704.04,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"119","median_amount":1733.0,"10th_percentile":1170.0,"90th_percentile":3794.55,"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":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"23","median_amount":2929.08,"10th_percentile":2419.0,"90th_percentile":5122.32},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":"91","median_amount":249.71,"10th_percentile":239.74,"90th_percentile":770.87,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"31","median_amount":542.05,"10th_percentile":460.55,"90th_percentile":544.05,"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":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"27","median_amount":514.39,"10th_percentile":249.71,"90th_percentile":666.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"568","median_amount":1733.0,"10th_percentile":1170.0,"90th_percentile":5083.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"66","median_amount":606.55,"10th_percentile":409.5,"90th_percentile":2565.2},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":542.05,"10th_percentile":409.5,"90th_percentile":544.26,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"61","median_amount":249.71,"10th_percentile":239.74,"90th_percentile":740.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":488.34,"10th_percentile":488.34,"90th_percentile":488.34,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"165","median_amount":542.05,"10th_percentile":497.95,"90th_percentile":545.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":666.72,"10th_percentile":666.72,"90th_percentile":790.85,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":433.64,"10th_percentile":433.64,"90th_percentile":433.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"135","median_amount":249.71,"10th_percentile":239.74,"90th_percentile":676.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"12","median_amount":433.64,"10th_percentile":419.07,"90th_percentile":704.75,"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 Healthcare","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":254.7,"10th_percentile":247.43,"90th_percentile":498.28,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"128","median_amount":727.0,"10th_percentile":432.0,"90th_percentile":1284.0,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"13","median_amount":664.0,"10th_percentile":464.8,"90th_percentile":1371.0,"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":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"131","median_amount":543.05,"10th_percentile":433.65,"90th_percentile":698.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Diagnostic Tests and Related Services","code_information":[{"code":"5724","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"127","median_amount":1990.0,"10th_percentile":1596.88,"90th_percentile":2512.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"22","median_amount":992.62,"10th_percentile":953.0,"90th_percentile":992.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"128","median_amount":1040.84,"10th_percentile":365.95,"90th_percentile":1408.17,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"66","median_amount":4863.0,"10th_percentile":4398.83,"90th_percentile":6900.2,"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":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"16","median_amount":290.0,"10th_percentile":30.0,"90th_percentile":27071.16},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":953.0,"10th_percentile":102.0,"90th_percentile":992.62,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"33","median_amount":1041.34,"10th_percentile":1039.34,"90th_percentile":1410.17,"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":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"20","median_amount":986.31,"10th_percentile":193.35,"90th_percentile":1908.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"567","median_amount":4772.0,"10th_percentile":4378.0,"90th_percentile":6803.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"52","median_amount":1670.2,"10th_percentile":1121.78,"90th_percentile":2315.44},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1039.34,"10th_percentile":962.98,"90th_percentile":1776.0,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"32","median_amount":992.62,"10th_percentile":5.5,"90th_percentile":992.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1263.76,"10th_percentile":935.91,"90th_percentile":1767.87,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"143","median_amount":1041.24,"10th_percentile":955.13,"90th_percentile":1415.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1022.71,"10th_percentile":1022.71,"90th_percentile":1381.7,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":831.47,"10th_percentile":831.47,"90th_percentile":831.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"64","median_amount":992.62,"10th_percentile":229.18,"90th_percentile":992.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1123.33,"10th_percentile":992.62,"90th_percentile":2177.0,"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 Healthcare","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":1012.47,"10th_percentile":475.75,"90th_percentile":1012.47,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"105","median_amount":1284.0,"10th_percentile":898.8,"90th_percentile":1906.0,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"14","median_amount":1172.0,"10th_percentile":1127.0,"90th_percentile":1741.0,"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":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"104","median_amount":1040.34,"10th_percentile":982.65,"90th_percentile":1409.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":978.92,"10th_percentile":978.92,"90th_percentile":978.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 1 Minor Procedures","code_information":[{"code":"5731","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"1 through 10","median_amount":2898.05,"10th_percentile":78.0,"90th_percentile":9765.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":67.45,"10th_percentile":67.45,"90th_percentile":67.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":25.53,"10th_percentile":25.02,"90th_percentile":45.45,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"1 through 10","median_amount":186.0,"10th_percentile":186.0,"90th_percentile":186.0,"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":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":30.0,"10th_percentile":30.0,"90th_percentile":30.0,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":122.44,"10th_percentile":97.63,"90th_percentile":122.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"1 through 10","median_amount":163.0,"10th_percentile":30.0,"90th_percentile":62974.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":101.22,"10th_percentile":101.22,"90th_percentile":101.22},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":40.49,"10th_percentile":40.49,"90th_percentile":5263.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":25.02,"10th_percentile":10.0,"90th_percentile":25.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":30.0,"10th_percentile":25.27,"90th_percentile":128.17,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":45.45,"10th_percentile":45.45,"90th_percentile":70.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","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":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"1 through 10","median_amount":150.0,"10th_percentile":150.0,"90th_percentile":150.0,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":25.42,"10th_percentile":25.42,"90th_percentile":25.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Minor Procedures","code_information":[{"code":"5732","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"1 through 10","median_amount":50.46,"10th_percentile":29.2,"90th_percentile":19382.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":70.25,"10th_percentile":70.25,"90th_percentile":70.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"47","median_amount":40.91,"10th_percentile":40.09,"90th_percentile":240.54,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":32.08,"10th_percentile":32.08,"90th_percentile":32.08,"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":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"13","median_amount":190.0,"10th_percentile":52.09,"90th_percentile":1277.0,"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":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"1 through 10","median_amount":380.0,"10th_percentile":380.0,"90th_percentile":380.0},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":68.0,"10th_percentile":46.76,"90th_percentile":68.0,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":40.09,"10th_percentile":36.08,"90th_percentile":72.95,"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":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"11","median_amount":61.44,"10th_percentile":27.79,"90th_percentile":122.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"75","median_amount":68.0,"10th_percentile":40.0,"90th_percentile":727.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":223.68,"10th_percentile":23.8,"90th_percentile":18260.36},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":189.4,"10th_percentile":189.4,"90th_percentile":189.4,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":94.92,"10th_percentile":67.45,"90th_percentile":343.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":36.58,"10th_percentile":36.58,"90th_percentile":36.58,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"20","median_amount":40.49,"10th_percentile":40.09,"90th_percentile":5963.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":120.75,"10th_percentile":80.0,"90th_percentile":188.49,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":68.0,"10th_percentile":67.45,"90th_percentile":5417.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":28.95,"10th_percentile":28.95,"90th_percentile":31.36,"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 Healthcare","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":68.0,"10th_percentile":68.0,"90th_percentile":68.0,"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":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"22","median_amount":68.0,"10th_percentile":33.65,"90th_percentile":337.0,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"17","median_amount":40.3,"10th_percentile":37.7,"90th_percentile":202.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Minor Procedures","code_information":[{"code":"5733","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"1547","median_amount":59.13,"10th_percentile":33.25,"90th_percentile":156.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"615","median_amount":32.28,"10th_percentile":31.0,"90th_percentile":105.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"3168","median_amount":60.87,"10th_percentile":57.79,"90th_percentile":61.92,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"39","median_amount":132.19,"10th_percentile":49.16,"90th_percentile":166.69,"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":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"1147","median_amount":81.0,"10th_percentile":61.0,"90th_percentile":330.0,"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":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"80","median_amount":19433.88,"10th_percentile":48.55,"90th_percentile":35022.55},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"1 through 10","median_amount":81.0,"10th_percentile":70.0,"90th_percentile":273.0,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"467","median_amount":61.0,"10th_percentile":31.0,"90th_percentile":105.38,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"655","median_amount":60.68,"10th_percentile":57.49,"90th_percentile":61.92,"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":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"381","median_amount":122.44,"10th_percentile":56.44,"90th_percentile":134.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"7772","median_amount":81.0,"10th_percentile":61.0,"90th_percentile":330.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"752","median_amount":28.35,"10th_percentile":21.35,"90th_percentile":115.5},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"148","median_amount":60.68,"10th_percentile":57.49,"90th_percentile":61.9,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"336","median_amount":67.45,"10th_percentile":31.0,"90th_percentile":105.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"111","median_amount":55.12,"10th_percentile":30.12,"90th_percentile":55.62,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"2985","median_amount":61.0,"10th_percentile":41.08,"90th_percentile":61.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"185","median_amount":161.94,"10th_percentile":61.0,"90th_percentile":211.68,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":60.93,"10th_percentile":60.93,"90th_percentile":60.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1182","median_amount":43.33,"10th_percentile":31.0,"90th_percentile":105.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"114","median_amount":48.55,"10th_percentile":43.46,"90th_percentile":132.19,"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 Healthcare","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":"111","median_amount":61.0,"10th_percentile":31.62,"90th_percentile":107.49,"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":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"1931","median_amount":81.0,"10th_percentile":61.0,"90th_percentile":196.0,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"200","median_amount":81.0,"10th_percentile":64.8,"90th_percentile":178.0,"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":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"2627","median_amount":60.69,"10th_percentile":32.28,"90th_percentile":61.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":122.02,"10th_percentile":122.02,"90th_percentile":122.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 4 Minor Procedures","code_information":[{"code":"5734","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"437","median_amount":157.68,"10th_percentile":97.2,"90th_percentile":600.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"270","median_amount":108.22,"10th_percentile":28.8,"90th_percentile":199.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"973","median_amount":131.68,"10th_percentile":118.28,"90th_percentile":133.68,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"16","median_amount":132.19,"10th_percentile":105.35,"90th_percentile":132.22,"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":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"336","median_amount":272.0,"10th_percentile":146.0,"90th_percentile":1332.0,"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":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"97","median_amount":45.0,"10th_percentile":9.09,"90th_percentile":54022.91},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":"279","median_amount":91.9,"10th_percentile":15.05,"90th_percentile":237.4,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"194","median_amount":131.68,"10th_percentile":119.65,"90th_percentile":133.68,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"130","median_amount":122.44,"10th_percentile":74.92,"90th_percentile":124.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"1706","median_amount":246.0,"10th_percentile":146.0,"90th_percentile":1153.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"201","median_amount":125.3,"10th_percentile":51.1,"90th_percentile":723.86},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"50","median_amount":131.68,"10th_percentile":86.45,"90th_percentile":134.82,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"163","median_amount":70.25,"10th_percentile":12.8,"90th_percentile":173.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"32","median_amount":118.51,"10th_percentile":94.01,"90th_percentile":120.41,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1080","median_amount":131.68,"10th_percentile":119.65,"90th_percentile":132.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"72","median_amount":161.97,"10th_percentile":128.0,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":105.35,"10th_percentile":105.35,"90th_percentile":132.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"452","median_amount":94.6,"10th_percentile":19.74,"90th_percentile":195.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"63","median_amount":131.68,"10th_percentile":100.35,"90th_percentile":133.18,"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 Healthcare","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":71.66,"10th_percentile":24.74,"90th_percentile":203.22,"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":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"422","median_amount":216.0,"10th_percentile":146.0,"90th_percentile":344.0,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"52","median_amount":199.0,"10th_percentile":146.0,"90th_percentile":895.0,"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":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"728","median_amount":131.69,"10th_percentile":105.35,"90th_percentile":133.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 5 Minor Procedures","code_information":[{"code":"5735","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"1 through 10","median_amount":7752.8,"10th_percentile":7752.8,"90th_percentile":9459.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":391.82,"10th_percentile":391.02,"90th_percentile":1056.49,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"1 through 10","median_amount":2212.87,"10th_percentile":2016.45,"90th_percentile":379284.12,"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":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"1 through 10","median_amount":377023.72,"10th_percentile":377023.72,"90th_percentile":377023.72},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":369.24,"10th_percentile":369.24,"90th_percentile":369.24,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":191.27,"10th_percentile":191.27,"90th_percentile":191.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"24","median_amount":1903.0,"10th_percentile":926.0,"90th_percentile":377591.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":514.45,"10th_percentile":514.45,"90th_percentile":514.45},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":368.45,"10th_percentile":368.45,"90th_percentile":368.45,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":199.05,"10th_percentile":199.05,"90th_percentile":199.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1496.46,"10th_percentile":528.51,"90th_percentile":1616.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","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":371.05,"10th_percentile":371.05,"90th_percentile":371.05,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"1 through 10","median_amount":432.0,"10th_percentile":432.0,"90th_percentile":432.0,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Electronic Analysis of Devices","code_information":[{"code":"5741","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"132","median_amount":75.19,"10th_percentile":46.64,"90th_percentile":148.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"87","median_amount":45.45,"10th_percentile":43.64,"90th_percentile":52.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"778","median_amount":38.09,"10th_percentile":34.92,"90th_percentile":38.87,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"13","median_amount":38.25,"10th_percentile":30.48,"90th_percentile":38.25,"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":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"115","median_amount":103.0,"10th_percentile":98.98,"90th_percentile":288.0,"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":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"1 through 10","median_amount":103.0,"10th_percentile":103.0,"90th_percentile":318.48},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":"33","median_amount":45.45,"10th_percentile":43.64,"90th_percentile":52.4,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"207","median_amount":38.09,"10th_percentile":35.44,"90th_percentile":38.87,"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":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"46","median_amount":35.43,"10th_percentile":32.96,"90th_percentile":36.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"815","median_amount":103.0,"10th_percentile":98.09,"90th_percentile":318.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"65","median_amount":36.05,"10th_percentile":36.05,"90th_percentile":61.8},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"24","median_amount":38.25,"10th_percentile":35.63,"90th_percentile":38.87,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":38.59,"10th_percentile":38.59,"90th_percentile":38.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"20","median_amount":34.28,"10th_percentile":34.28,"90th_percentile":34.28,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"879","median_amount":38.09,"10th_percentile":18.49,"90th_percentile":38.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"34","median_amount":46.85,"10th_percentile":43.44,"90th_percentile":89.99,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":30.48,"10th_percentile":30.48,"90th_percentile":30.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"121","median_amount":45.45,"10th_percentile":43.64,"90th_percentile":52.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"42","median_amount":38.25,"10th_percentile":38.25,"90th_percentile":38.87,"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":"Molina Healthcare","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":46.36,"10th_percentile":45.03,"90th_percentile":249.44,"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":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"125","median_amount":103.0,"10th_percentile":56.36,"90th_percentile":346.0,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"19","median_amount":103.0,"10th_percentile":93.47,"90th_percentile":647.0,"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":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"425","median_amount":38.1,"10th_percentile":30.48,"90th_percentile":38.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Electronic Analysis of Devices","code_information":[{"code":"5742","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":95.68,"10th_percentile":95.68,"90th_percentile":95.68,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":88.98,"10th_percentile":88.98,"90th_percentile":122.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"19","median_amount":470.0,"10th_percentile":470.0,"90th_percentile":923.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":254.21,"10th_percentile":115.34,"90th_percentile":277.28,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"22","median_amount":56.95,"10th_percentile":43.64,"90th_percentile":140.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":194.05,"10th_percentile":194.05,"90th_percentile":194.05,"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 Healthcare","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":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":94.77,"10th_percentile":94.77,"90th_percentile":94.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Electronic Analysis of Devices","code_information":[{"code":"5743","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":312.63,"10th_percentile":312.63,"90th_percentile":312.63,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"1 through 10","median_amount":991.0,"10th_percentile":991.0,"90th_percentile":2369.0},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","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":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Rehabilitation","code_information":[{"code":"5771","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"84","median_amount":1277.5,"10th_percentile":472.5,"90th_percentile":2555.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"200","median_amount":771.72,"10th_percentile":257.24,"90th_percentile":1311.96,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"81","median_amount":2100.0,"10th_percentile":573.0,"90th_percentile":3850.0,"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":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"1 through 10","median_amount":1800.0,"10th_percentile":1800.0,"90th_percentile":1800.0,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"34","median_amount":646.1,"10th_percentile":297.66,"90th_percentile":1210.28,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":119.62,"10th_percentile":119.62,"90th_percentile":119.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"414","median_amount":2100.0,"10th_percentile":700.0,"90th_percentile":3850.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"45","median_amount":612.5,"10th_percentile":200.55,"90th_percentile":1347.5},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":515.28,"10th_percentile":237.64,"90th_percentile":1545.84,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":210.09,"10th_percentile":210.09,"90th_percentile":210.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"181","median_amount":771.72,"10th_percentile":257.24,"90th_percentile":1414.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1317.38,"10th_percentile":1317.38,"90th_percentile":1317.38,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":349.37,"10th_percentile":349.37,"90th_percentile":823.2,"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 Healthcare","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":532.52,"10th_percentile":532.52,"90th_percentile":532.52,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"72","median_amount":1185.0,"10th_percentile":237.0,"90th_percentile":2304.18,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"21","median_amount":1302.0,"10th_percentile":868.0,"90th_percentile":2170.0,"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":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"163","median_amount":776.4,"10th_percentile":257.26,"90th_percentile":1414.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Resuscitation and Cardioversion","code_information":[{"code":"5781","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"11","median_amount":4565.29,"10th_percentile":2600.4,"90th_percentile":7144.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":747.11,"10th_percentile":700.36,"90th_percentile":778.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"67","median_amount":670.54,"10th_percentile":668.5,"90th_percentile":1233.64,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"11","median_amount":8997.67,"10th_percentile":6875.43,"90th_percentile":10633.55,"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":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"1 through 10","median_amount":9403.36,"10th_percentile":6360.39,"90th_percentile":13865.62},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":1321.96,"10th_percentile":1321.96,"90th_percentile":1321.96,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"12","median_amount":670.5,"10th_percentile":668.5,"90th_percentile":1228.63,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1142.62,"10th_percentile":1142.62,"90th_percentile":1420.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"85","median_amount":9514.02,"10th_percentile":6674.03,"90th_percentile":14951.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"13","median_amount":3252.88,"10th_percentile":2307.3,"90th_percentile":3533.97},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":675.0,"10th_percentile":675.0,"90th_percentile":675.0,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1106.26,"10th_percentile":602.15,"90th_percentile":2434.37,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"54","median_amount":670.4,"10th_percentile":648.9,"90th_percentile":1231.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":778.17,"10th_percentile":778.17,"90th_percentile":778.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":671.23,"10th_percentile":671.23,"90th_percentile":671.23,"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 Healthcare","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":793.73,"10th_percentile":793.73,"90th_percentile":793.73,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"27","median_amount":1951.0,"10th_percentile":989.1,"90th_percentile":3096.5,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"1 through 10","median_amount":3978.0,"10th_percentile":3978.0,"90th_percentile":3978.0,"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":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"41","median_amount":673.5,"10th_percentile":668.5,"90th_percentile":1239.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pulmonary Treatment","code_information":[{"code":"5791","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"32","median_amount":3114.28,"10th_percentile":670.0,"90th_percentile":3123.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"14","median_amount":406.27,"10th_percentile":252.87,"90th_percentile":571.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"12","median_amount":207.78,"10th_percentile":163.2,"90th_percentile":3886.6,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"17","median_amount":2631.41,"10th_percentile":1517.78,"90th_percentile":3673.0,"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":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"35","median_amount":3439.78,"10th_percentile":2656.52,"90th_percentile":5546.97},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":365.11,"10th_percentile":72.33,"90th_percentile":637.4,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":207.78,"10th_percentile":207.78,"90th_percentile":13743.87,"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":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":406.27,"10th_percentile":406.27,"90th_percentile":594.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"144","median_amount":3398.99,"10th_percentile":770.84,"90th_percentile":4972.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"17","median_amount":1106.58,"10th_percentile":621.6,"90th_percentile":17980.72},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":211.93,"10th_percentile":211.93,"90th_percentile":211.93,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"34","median_amount":260.62,"10th_percentile":190.65,"90th_percentile":518.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"15","median_amount":207.78,"10th_percentile":207.78,"90th_percentile":306.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"58","median_amount":260.62,"10th_percentile":135.09,"90th_percentile":468.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","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":477.67,"10th_percentile":257.93,"90th_percentile":1158.57,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"37","median_amount":1210.4,"10th_percentile":93.0,"90th_percentile":1513.0,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"1 through 10","median_amount":1382.0,"10th_percentile":1053.5,"90th_percentile":1382.0,"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":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"12","median_amount":207.78,"10th_percentile":166.23,"90th_percentile":268.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1440.54,"10th_percentile":1440.54,"90th_percentile":1440.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Ventilation Initiation and Management","code_information":[{"code":"5801","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"1 through 10","median_amount":3496.98,"10th_percentile":3496.98,"90th_percentile":3496.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2704.85,"10th_percentile":2704.85,"90th_percentile":2704.85,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","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":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Manipulation Therapy","code_information":[{"code":"5811","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":24.52,"10th_percentile":23.14,"90th_percentile":24.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","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":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Health and Behavior Services","code_information":[{"code":"5821","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"1 through 10","median_amount":83.95,"10th_percentile":83.95,"90th_percentile":168.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":142.25,"10th_percentile":142.25,"90th_percentile":142.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":31.05,"10th_percentile":31.05,"90th_percentile":31.05,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":163.24,"10th_percentile":163.24,"90th_percentile":163.24,"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":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"1 through 10","median_amount":30.43,"10th_percentile":30.43,"90th_percentile":30.43},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":60.68,"10th_percentile":60.68,"90th_percentile":60.68,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":150.74,"10th_percentile":28.3,"90th_percentile":150.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"25","median_amount":111.25,"10th_percentile":34.0,"90th_percentile":115.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":13.8,"10th_percentile":13.8,"90th_percentile":13.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":27.39,"10th_percentile":27.39,"90th_percentile":27.39,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":30.43,"10th_percentile":30.43,"90th_percentile":174.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":34.0,"10th_percentile":33.32,"90th_percentile":185.07,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":32.28,"10th_percentile":32.28,"90th_percentile":32.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":28.95,"10th_percentile":28.95,"90th_percentile":30.43,"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":"Molina Healthcare","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":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"1 through 10","median_amount":115.0,"10th_percentile":115.0,"90th_percentile":115.0,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"1 through 10","median_amount":115.0,"10th_percentile":115.0,"90th_percentile":115.0,"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":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":31.05,"10th_percentile":31.05,"90th_percentile":31.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Health and Behavior Services","code_information":[{"code":"5822","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"197","median_amount":159.6,"10th_percentile":81.6,"90th_percentile":1553.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"43","median_amount":616.79,"10th_percentile":162.53,"90th_percentile":800.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"201","median_amount":94.49,"10th_percentile":83.78,"90th_percentile":95.29,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":137.58,"10th_percentile":137.58,"90th_percentile":137.58,"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":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"51","median_amount":780.0,"10th_percentile":195.0,"90th_percentile":5490.0,"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":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"123","median_amount":1952.0,"10th_percentile":128.0,"90th_percentile":6784.0},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":631.56,"10th_percentile":89.09,"90th_percentile":2506.95,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"18","median_amount":94.88,"10th_percentile":83.49,"90th_percentile":2360.12,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"39","median_amount":122.44,"10th_percentile":56.23,"90th_percentile":986.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"342","median_amount":390.0,"10th_percentile":89.0,"90th_percentile":4980.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"27","median_amount":624.0,"10th_percentile":221.0,"90th_percentile":3315.0},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":61.86,"10th_percentile":61.86,"90th_percentile":61.86,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":83.78,"10th_percentile":83.78,"90th_percentile":83.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"40","median_amount":471.69,"10th_percentile":61.86,"90th_percentile":2648.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"11","median_amount":85.04,"10th_percentile":85.04,"90th_percentile":85.47,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"77","median_amount":94.49,"10th_percentile":89.0,"90th_percentile":190.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"13","median_amount":181.01,"10th_percentile":89.0,"90th_percentile":287.99,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"96","median_amount":184.42,"10th_percentile":89.09,"90th_percentile":1729.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"27","median_amount":139.98,"10th_percentile":79.0,"90th_percentile":190.78,"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":"Molina Healthcare","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":810.56,"10th_percentile":481.11,"90th_percentile":3207.4,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"143","median_amount":132.3,"10th_percentile":62.3,"90th_percentile":1260.0,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"21","median_amount":89.52,"10th_percentile":57.32,"90th_percentile":121.72,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"101","median_amount":94.5,"10th_percentile":83.79,"90th_percentile":94.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1572.3,"10th_percentile":1572.3,"90th_percentile":1572.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 3 Health and Behavior Services","code_information":[{"code":"5823","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"47","median_amount":1263.5,"10th_percentile":213.75,"90th_percentile":4000.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"29","median_amount":319.92,"10th_percentile":106.64,"90th_percentile":2803.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":164.81,"10th_percentile":164.81,"90th_percentile":4438.4,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":632.37,"10th_percentile":632.37,"90th_percentile":772.15,"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":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"47","median_amount":4288.0,"10th_percentile":295.0,"90th_percentile":7370.0,"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":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"165","median_amount":4399.02,"10th_percentile":380.0,"90th_percentile":7608.0},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":380.0,"10th_percentile":106.64,"90th_percentile":3955.03,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":716.6,"10th_percentile":164.81,"90th_percentile":2261.25,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":275.11,"10th_percentile":156.8,"90th_percentile":275.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"263","median_amount":3040.0,"10th_percentile":357.09,"90th_percentile":7355.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"31","median_amount":1768.0,"10th_percentile":326.0,"90th_percentile":4289.0},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"59","median_amount":218.08,"10th_percentile":106.64,"90th_percentile":1435.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":166.04,"10th_percentile":67.0,"90th_percentile":1493.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"113","median_amount":319.92,"10th_percentile":106.64,"90th_percentile":1282.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":249.78,"10th_percentile":157.44,"90th_percentile":419.07,"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":"Molina Healthcare","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":244.08,"10th_percentile":108.77,"90th_percentile":2938.05,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"34","median_amount":2523.2,"10th_percentile":623.71,"90th_percentile":4508.0,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"1 through 10","median_amount":1349.12,"10th_percentile":1349.12,"90th_percentile":4866.38,"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":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1155.73,"10th_percentile":816.74,"90th_percentile":5040.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"11","median_amount":213.28,"10th_percentile":206.32,"90th_percentile":463.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Dental Procedures","code_information":[{"code":"5871","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":195.6,"10th_percentile":195.6,"90th_percentile":341.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":765.57,"10th_percentile":765.57,"90th_percentile":765.57,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"1 through 10","median_amount":1811.07,"10th_percentile":1811.07,"90th_percentile":1811.07,"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":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"1 through 10","median_amount":2143.74,"10th_percentile":2143.74,"90th_percentile":2143.74},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":161.51,"10th_percentile":161.51,"90th_percentile":161.51,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"1 through 10","median_amount":3799.57,"10th_percentile":3799.57,"90th_percentile":3799.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1353.96,"10th_percentile":1353.96,"90th_percentile":1353.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":457.17,"10th_percentile":457.17,"90th_percentile":457.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","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":158.17,"10th_percentile":158.17,"90th_percentile":158.17,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"1 through 10","median_amount":762.0,"10th_percentile":762.0,"90th_percentile":762.0,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"1 through 10","median_amount":5054.23,"10th_percentile":5054.23,"90th_percentile":5054.23,"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":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Covid-19 Vaccine Administration","code_information":[{"code":"9398","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":109.09,"10th_percentile":109.09,"90th_percentile":109.09,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":68.04,"10th_percentile":68.04,"90th_percentile":68.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":134.19,"10th_percentile":134.19,"90th_percentile":134.19,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","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":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Platelet pheres leukoreduced","code_information":[{"code":"9501","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"1 through 10","median_amount":55291.99,"10th_percentile":55291.99,"90th_percentile":55291.99,"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":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":9449.94,"10th_percentile":9449.94,"90th_percentile":9449.94},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3605.18,"10th_percentile":3605.18,"90th_percentile":13467.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","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":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"1 through 10","median_amount":10467.2,"10th_percentile":10467.2,"90th_percentile":10467.2,"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":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"RBC leukocytes reduced","code_information":[{"code":"9512","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2704.85,"10th_percentile":2704.85,"90th_percentile":2704.85,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"1 through 10","median_amount":10130.25,"10th_percentile":10130.25,"90th_percentile":10130.25},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"1 through 10","median_amount":5194.0,"10th_percentile":5194.0,"90th_percentile":5194.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","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":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"1 through 10","median_amount":1210.4,"10th_percentile":1210.4,"90th_percentile":1210.4,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"RBC leukoreduced irradiated","code_information":[{"code":"9522","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1382.99,"10th_percentile":1382.99,"90th_percentile":1382.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","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":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Plate pheres leukoredu irrad","code_information":[{"code":"9530","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"1 through 10","median_amount":12245.0,"10th_percentile":12245.0,"90th_percentile":12560.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2423.95,"10th_percentile":2423.95,"90th_percentile":2423.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","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":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2298.13,"10th_percentile":2298.13,"90th_percentile":2298.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-OPPS Clinic Services","code_information":[{"code":"N700","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"162","median_amount":81.6,"10th_percentile":51.6,"90th_percentile":81.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"191","median_amount":208.59,"10th_percentile":151.05,"90th_percentile":314.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"423","median_amount":131.65,"10th_percentile":99.96,"90th_percentile":132.45,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"264","median_amount":132.19,"10th_percentile":49.16,"90th_percentile":132.19,"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":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"192","median_amount":140.0,"10th_percentile":124.08,"90th_percentile":140.0,"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":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"222","median_amount":8.83,"10th_percentile":8.83,"90th_percentile":17.66},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":"205","median_amount":140.0,"10th_percentile":140.0,"90th_percentile":195.42,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"79","median_amount":131.65,"10th_percentile":124.23,"90th_percentile":131.65,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"2422","median_amount":122.44,"10th_percentile":122.44,"90th_percentile":132.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"1016","median_amount":140.0,"10th_percentile":127.21,"90th_percentile":140.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"117","median_amount":49.0,"10th_percentile":43.75,"90th_percentile":49.0},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":134.34,"10th_percentile":134.34,"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."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":42.13,"10th_percentile":42.13,"90th_percentile":42.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"194","median_amount":140.0,"10th_percentile":129.0,"90th_percentile":215.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":181.62,"10th_percentile":181.62,"90th_percentile":181.62,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"416","median_amount":131.65,"10th_percentile":131.65,"90th_percentile":132.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1031","median_amount":132.0,"10th_percentile":125.0,"90th_percentile":132.0,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":105.32,"10th_percentile":105.32,"90th_percentile":105.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"350","median_amount":140.0,"10th_percentile":111.44,"90th_percentile":206.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"128","median_amount":129.89,"10th_percentile":125.0,"90th_percentile":132.0,"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 Healthcare","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":140.0,"10th_percentile":109.53,"90th_percentile":204.18,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"230","median_amount":98.0,"10th_percentile":83.3,"90th_percentile":98.0,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"15","median_amount":90.16,"10th_percentile":83.08,"90th_percentile":180.32,"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":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"360","median_amount":131.66,"10th_percentile":124.24,"90th_percentile":132.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":107.38,"10th_percentile":103.88,"90th_percentile":139.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Clinical Diagnostic Lab Services","code_information":[{"code":"N800","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"11335","median_amount":144.58,"10th_percentile":35.63,"90th_percentile":326.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"6068","median_amount":37.83,"10th_percentile":10.43,"90th_percentile":134.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"15927","median_amount":49.99,"10th_percentile":12.3,"90th_percentile":131.65,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"168","median_amount":68.53,"10th_percentile":18.43,"90th_percentile":171.36,"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":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"8095","median_amount":355.0,"10th_percentile":108.12,"90th_percentile":969.0,"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":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"2620","median_amount":28.5,"10th_percentile":8.83,"90th_percentile":263.0},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"13","median_amount":191.0,"10th_percentile":165.0,"90th_percentile":635.0,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"8406","median_amount":35.03,"10th_percentile":10.43,"90th_percentile":121.04,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"3437","median_amount":49.27,"10th_percentile":11.85,"90th_percentile":131.65,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1931","median_amount":63.56,"10th_percentile":16.19,"90th_percentile":158.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"50982","median_amount":355.0,"10th_percentile":108.0,"90th_percentile":940.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"6027","median_amount":125.3,"10th_percentile":44.41,"90th_percentile":338.1},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"681","median_amount":50.51,"10th_percentile":13.11,"90th_percentile":134.68,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"22","median_amount":29.32,"10th_percentile":18.36,"90th_percentile":131.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"5008","median_amount":35.84,"10th_percentile":10.3,"90th_percentile":130.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"694","median_amount":53.93,"10th_percentile":15.48,"90th_percentile":108.03,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"17979","median_amount":52.07,"10th_percentile":13.12,"90th_percentile":131.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"971","median_amount":107.93,"10th_percentile":20.82,"90th_percentile":208.74,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":28.71,"10th_percentile":26.28,"90th_percentile":82.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"15146","median_amount":31.88,"10th_percentile":10.3,"90th_percentile":108.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1137","median_amount":53.79,"10th_percentile":16.69,"90th_percentile":138.81,"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 Healthcare","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":"1320","median_amount":40.71,"10th_percentile":10.64,"90th_percentile":138.74,"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":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"11757","median_amount":217.0,"10th_percentile":89.0,"90th_percentile":370.0,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"1322","median_amount":199.0,"10th_percentile":108.0,"90th_percentile":370.0,"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":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"11112","median_amount":54.23,"10th_percentile":13.12,"90th_percentile":131.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"60","median_amount":16.1,"10th_percentile":10.3,"90th_percentile":65.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Therapy Services","code_information":[{"code":"N801","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"3302","median_amount":430.61,"10th_percentile":119.9,"90th_percentile":1235.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1288","median_amount":226.35,"10th_percentile":45.27,"90th_percentile":555.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"4067","median_amount":196.51,"10th_percentile":72.23,"90th_percentile":463.11,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"11","median_amount":133.48,"10th_percentile":40.04,"90th_percentile":282.11,"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":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"2271","median_amount":869.0,"10th_percentile":222.0,"90th_percentile":2363.0,"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":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"3973","median_amount":80.0,"10th_percentile":29.25,"90th_percentile":210.0},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"1 through 10","median_amount":1974.0,"10th_percentile":1974.0,"90th_percentile":3388.94,"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":"BCBS","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":"1643","median_amount":336.41,"10th_percentile":96.93,"90th_percentile":798.24,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"677","median_amount":193.62,"10th_percentile":71.79,"90th_percentile":435.48,"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":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"353","median_amount":210.72,"10th_percentile":67.81,"90th_percentile":478.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"13432","median_amount":869.0,"10th_percentile":221.78,"90th_percentile":2387.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1525","median_amount":311.15,"10th_percentile":92.4,"90th_percentile":866.6},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"144","median_amount":163.66,"10th_percentile":53.99,"90th_percentile":416.24,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":145.18,"10th_percentile":145.18,"90th_percentile":181.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1335","median_amount":231.19,"10th_percentile":45.27,"90th_percentile":509.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"92","median_amount":152.39,"10th_percentile":56.3,"90th_percentile":375.13,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"3818","median_amount":197.68,"10th_percentile":72.28,"90th_percentile":468.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"147","median_amount":304.73,"10th_percentile":96.35,"90th_percentile":709.52,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"3621","median_amount":228.49,"10th_percentile":45.27,"90th_percentile":554.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"342","median_amount":197.03,"10th_percentile":66.21,"90th_percentile":427.75,"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 Healthcare","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":"337","median_amount":265.98,"10th_percentile":46.18,"90th_percentile":587.7,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"3179","median_amount":654.0,"10th_percentile":180.0,"90th_percentile":1635.0,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"335","median_amount":594.0,"10th_percentile":200.0,"90th_percentile":1716.0,"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":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"2383","median_amount":193.52,"10th_percentile":70.66,"90th_percentile":447.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"13","median_amount":237.99,"10th_percentile":45.27,"90th_percentile":283.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Mammography Services","code_information":[{"code":"N804","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"2756","median_amount":389.82,"10th_percentile":185.3,"90th_percentile":389.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"286","median_amount":89.96,"10th_percentile":86.37,"90th_percentile":89.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"2741","median_amount":113.49,"10th_percentile":113.49,"90th_percentile":116.8,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"26","median_amount":139.79,"10th_percentile":114.63,"90th_percentile":139.79,"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":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"1564","median_amount":534.0,"10th_percentile":534.0,"90th_percentile":534.0,"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":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"71","median_amount":534.0,"10th_percentile":116.8,"90th_percentile":534.0},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"1 through 10","median_amount":534.0,"10th_percentile":534.0,"90th_percentile":534.0,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"243","median_amount":89.96,"10th_percentile":86.37,"90th_percentile":89.96,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"379","median_amount":113.49,"10th_percentile":113.49,"90th_percentile":116.8,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"114","median_amount":105.55,"10th_percentile":89.96,"90th_percentile":108.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"12881","median_amount":534.0,"10th_percentile":534.0,"90th_percentile":534.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1419","median_amount":186.9,"10th_percentile":186.9,"90th_percentile":186.9},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"90","median_amount":115.76,"10th_percentile":113.49,"90th_percentile":179.12,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":132.4,"10th_percentile":132.4,"90th_percentile":132.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"185","median_amount":87.39,"10th_percentile":86.37,"90th_percentile":89.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"60","median_amount":102.14,"10th_percentile":102.14,"90th_percentile":102.14,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"2198","median_amount":113.49,"10th_percentile":113.49,"90th_percentile":113.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"54","median_amount":139.6,"10th_percentile":116.8,"90th_percentile":139.6,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"11","median_amount":113.49,"10th_percentile":83.98,"90th_percentile":116.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"756","median_amount":89.96,"10th_percentile":86.37,"90th_percentile":89.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"94","median_amount":113.49,"10th_percentile":113.49,"90th_percentile":113.49,"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 Healthcare","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":"37","median_amount":91.76,"10th_percentile":88.1,"90th_percentile":91.76,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"3150","median_amount":281.0,"10th_percentile":268.0,"90th_percentile":281.0,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"366","median_amount":258.0,"10th_percentile":258.0,"90th_percentile":258.0,"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":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1517","median_amount":113.51,"10th_percentile":113.51,"90th_percentile":116.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Durable Medical Equipment","code_information":[{"code":"N805","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":104.7,"10th_percentile":104.7,"90th_percentile":104.7,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"1 through 10","median_amount":126.0,"10th_percentile":88.0,"90th_percentile":126.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":52.35,"10th_percentile":52.35,"90th_percentile":52.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","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":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"1 through 10","median_amount":88.2,"10th_percentile":88.2,"90th_percentile":88.2,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":59.65,"10th_percentile":59.65,"90th_percentile":59.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Medicine","code_information":[{"code":"N809","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"49","median_amount":484.72,"10th_percentile":189.98,"90th_percentile":872.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":283.26,"10th_percentile":86.92,"90th_percentile":624.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"80","median_amount":141.06,"10th_percentile":41.92,"90th_percentile":263.96,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":255.25,"10th_percentile":41.54,"90th_percentile":298.52,"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":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"31","median_amount":711.0,"10th_percentile":313.69,"90th_percentile":1358.0,"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":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"28","median_amount":60.0,"10th_percentile":20.0,"90th_percentile":153.51},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":724.11,"10th_percentile":399.12,"90th_percentile":1023.45,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"15","median_amount":140.48,"10th_percentile":98.73,"90th_percentile":268.93,"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":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":130.66,"10th_percentile":130.66,"90th_percentile":228.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"195","median_amount":711.0,"10th_percentile":347.0,"90th_percentile":1547.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"19","median_amount":281.05,"10th_percentile":186.64,"90th_percentile":682.5},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":174.06,"10th_percentile":174.06,"90th_percentile":174.06,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":364.53,"10th_percentile":364.53,"90th_percentile":364.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":115.02,"10th_percentile":99.51,"90th_percentile":211.46,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"64","median_amount":103.83,"10th_percentile":42.45,"90th_percentile":183.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":621.51,"10th_percentile":621.51,"90th_percentile":621.51,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"11","median_amount":283.26,"10th_percentile":45.27,"90th_percentile":624.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":162.88,"10th_percentile":162.88,"90th_percentile":162.88,"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 Healthcare","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":161.63,"10th_percentile":161.63,"90th_percentile":288.93,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"47","median_amount":624.0,"10th_percentile":207.86,"90th_percentile":1164.8,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"1 through 10","median_amount":297.0,"10th_percentile":207.9,"90th_percentile":1485.0,"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":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"26","median_amount":167.0,"10th_percentile":42.97,"90th_percentile":244.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Observation, Other","code_information":[{"code":"N811","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"18","median_amount":958.66,"10th_percentile":452.68,"90th_percentile":1121.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1180.29,"10th_percentile":1077.39,"90th_percentile":1255.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"17","median_amount":1009.0,"10th_percentile":953.0,"90th_percentile":1811.08,"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":"BCBS","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"31","median_amount":1009.0,"10th_percentile":953.0,"90th_percentile":1121.0},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":1065.0,"10th_percentile":1009.0,"90th_percentile":1180.29,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"79","median_amount":1009.0,"10th_percentile":917.99,"90th_percentile":1121.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"15","median_amount":353.15,"10th_percentile":282.52,"90th_percentile":357.8},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":878.81,"10th_percentile":878.81,"90th_percentile":2531.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"22","median_amount":1022.62,"10th_percentile":953.0,"90th_percentile":1193.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","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":1072.21,"10th_percentile":1072.21,"90th_percentile":1072.21,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"12","median_amount":953.0,"10th_percentile":5.94,"90th_percentile":1177.0,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-covered Services","code_information":[{"code":"N900","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"311","median_amount":381.79,"10th_percentile":155.72,"90th_percentile":477.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"39","median_amount":89.96,"10th_percentile":86.37,"90th_percentile":89.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":381.79,"10th_percentile":207.2,"90th_percentile":477.42,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"180","median_amount":523.0,"10th_percentile":523.0,"90th_percentile":654.0,"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":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"13","median_amount":101.57,"10th_percentile":40.0,"90th_percentile":654.0},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":"31","median_amount":89.96,"10th_percentile":59.97,"90th_percentile":92.88,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"28","median_amount":89.55,"10th_percentile":85.92,"90th_percentile":124.57,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":101.63,"10th_percentile":79.9,"90th_percentile":115.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"1526","median_amount":523.0,"10th_percentile":523.0,"90th_percentile":654.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"170","median_amount":183.05,"10th_percentile":183.05,"90th_percentile":228.9},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":87.63,"10th_percentile":85.92,"90th_percentile":109.27,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"18","median_amount":87.39,"10th_percentile":86.37,"90th_percentile":200.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":77.32,"10th_percentile":77.32,"90th_percentile":98.34,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"163","median_amount":109.27,"10th_percentile":85.92,"90th_percentile":109.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":154.95,"10th_percentile":154.95,"90th_percentile":154.95,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"115","median_amount":89.96,"10th_percentile":86.37,"90th_percentile":157.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":128.71,"10th_percentile":84.04,"90th_percentile":148.48,"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":"Molina Healthcare","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":91.76,"10th_percentile":91.76,"90th_percentile":91.76,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"333","median_amount":281.0,"10th_percentile":224.8,"90th_percentile":281.0,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"40","median_amount":258.0,"10th_percentile":258.0,"90th_percentile":281.0,"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":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"81","median_amount":109.27,"10th_percentile":85.92,"90th_percentile":120.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Anesthesia, bundled","code_information":[{"code":"N901","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"1 through 10","median_amount":2036.0,"10th_percentile":2036.0,"90th_percentile":2036.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","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":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Packaged Services","code_information":[{"code":"N902","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"1 through 10","median_amount":712.44,"10th_percentile":48.25,"90th_percentile":1254.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":22.01,"10th_percentile":22.01,"90th_percentile":22.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"16","median_amount":131.61,"10th_percentile":49.16,"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."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"1 through 10","median_amount":43973.77,"10th_percentile":43973.77,"90th_percentile":45761.4,"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":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"1 through 10","median_amount":1110.0,"10th_percentile":1110.0,"90th_percentile":1110.0},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","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":18.58,"10th_percentile":18.58,"90th_percentile":18.58,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":55.0,"10th_percentile":55.0,"90th_percentile":79.53,"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":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"77","median_amount":122.44,"10th_percentile":48.98,"90th_percentile":122.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"11","median_amount":1254.0,"10th_percentile":47.79,"90th_percentile":1958.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":617.4,"10th_percentile":617.4,"90th_percentile":617.4},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":9.52,"10th_percentile":9.52,"90th_percentile":9.52,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":252.91,"10th_percentile":252.91,"90th_percentile":411.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":11.7,"10th_percentile":9.52,"90th_percentile":681.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"37","median_amount":164.92,"10th_percentile":64.78,"90th_percentile":185.68,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":9.52,"10th_percentile":5.5,"90th_percentile":411.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":132.0,"10th_percentile":9.52,"90th_percentile":187.0,"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 Healthcare","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":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"1 through 10","median_amount":423.5,"10th_percentile":145.6,"90th_percentile":731.0,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Influenza Vaccines & Pneumococcal Pneumonia Vaccines","code_information":[{"code":"N903","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":188.0,"10th_percentile":188.0,"90th_percentile":188.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","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":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Not Recognized by OPPS","code_information":[{"code":"N905","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9691] [Cardiac Cath (%BC): 73] [Stereotactic Radiosurgery (%BC): 73] [Observation ($): 6246] [Emergency Department ($): 3123] [Clinic Visit ($): 81.60] [Sleep Studies-Attended ($): 1540] [Sleep Studies-Unattended ($): 490] [Chemotherapy (%BC): 73] [CT Scan OP ($): 2154] [MRI OP ($): 2693] [Positron Emission Tomography ($): 3230] [Laboratory (%BC): 45] [OP High Cost Drugs ($): 0 Charge Threshold 3500 (%BC): 32] [Other Outpatient Implant ($): 0 Charge Threshold 3500 (%BC): 29] [All Other OP (%BC): 73]","count":"152","median_amount":2375.54,"10th_percentile":1171.35,"90th_percentile":2467.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":511.24,"10th_percentile":511.24,"90th_percentile":617.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"51","median_amount":365.95,"10th_percentile":310.11,"90th_percentile":368.83,"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":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 41.20] [Observation (%BC): 39.83] [Emergency Department (%BC): 39.83] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 39.10 Maximum Reimbursement 144.50] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 39.75]","count":"144","median_amount":2482.0,"10th_percentile":2392.0,"90th_percentile":2562.0,"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":"HMO","methodology":"percent of total billed charges","standard_charge_percentage":41.58,"count":"1 through 10","median_amount":150.0,"10th_percentile":30.0,"90th_percentile":300.0},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 44.59] [Observation (%BC): 43.11] [Emergency Department (%BC): 43.11] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 42.32 Maximum Reimbursement 156.40] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 43.02]","count":"1 through 10","median_amount":2267.32,"10th_percentile":2267.32,"90th_percentile":2267.32,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":511.24,"10th_percentile":307.07,"90th_percentile":864.25,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":366.32,"10th_percentile":366.32,"90th_percentile":370.83,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":339.3,"10th_percentile":339.3,"90th_percentile":339.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 48.47] [Observation (%BC): 48.46] [Emergency Department (%BC): 48.46] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 46 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 46.76]","count":"971","median_amount":2482.0,"10th_percentile":2362.38,"90th_percentile":2576.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"114","median_amount":812.7,"10th_percentile":718.37,"90th_percentile":812.7},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":95.33,"10th_percentile":95.33,"90th_percentile":95.33,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":490.83,"10th_percentile":307.07,"90th_percentile":617.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"28","median_amount":367.83,"10th_percentile":364.83,"90th_percentile":372.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":580.99,"10th_percentile":580.99,"90th_percentile":580.99,"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":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"35","median_amount":511.24,"10th_percentile":490.83,"90th_percentile":511.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":366.32,"10th_percentile":366.32,"90th_percentile":366.32,"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":"Molina Healthcare","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":500.65,"10th_percentile":500.65,"90th_percentile":500.65,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2664] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 91892] [Insertion of Permanent Pacemaker ($): 35673] [PTCA w/ Drug Eluting Stent ($): 30647] [PTCA w/non Drug Eluting Stent ($): 23645] [PTCA w/out stent ($): 23090] [Stereotactic Radiosurgery (%BC): 70] [Stereotactic Radiosurgery-Fractionated (%BC): 70] [Observation ($): 4356] [Emergency Department ($): 1513] [Urgent Care ($): 196] [Cardiac Rehabilitation Therapy ($): 237] [Cardiac Stress Test ($): 812] [Cardiology ($): 1734] [Echocardiology ($): 1254] [EKG/ECG ($): 196] [Electrophysiology Ablation ($): 13134] [Electrophysiology and Mapping Studies ($): 8024] [Holter Monitor/Telemetry ($): 346] [Peripheral Vascular Lab ($): 1082] [EEG ($): 3954] [EMG ($): 727] [Neuropsychological Testing and Biofeedback ($): 592] [Sleep Studies ($): 1284] [Chemotherapy (%BC): 70] [Nuclear Medicine ($): 3417] [Oncology (%BC): 70] [Radiation Therapy  (%BC): 70] [CT Scan OP ($): 1689] [MRI OP ($): 2814] [Imaging Services ($): 138] [Mammography-Diagnostic ($): 281] [Mammography-Screening ($): 281] [Positron Emission Tomography ($): 4326] [Radiology ($): 581] [Ultrasound Imaging ($): 731] [Laboratory ($): 217] [Pathology ($): 217] [Hemodialysis (%BC): 70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70] [Occupational Therapy ($): 327] [Physical Therapy ($): 327] [Resp. Services/Therapy ($): 93] [Speech Therapy ($): 327] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1164] [IV Therapy (%BC): 70] [Pulmonary Function ($): 592]","count":"176","median_amount":2472.0,"10th_percentile":1824.0,"90th_percentile":2592.0,"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2435] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 83936] [Insertion of Permanent Pacemaker ($): 32583] [PTCA w/ Drug Eluting Stent ($): 27992] [PTCA w/non Drug Eluting Stent ($): 21598] [PTCA w/out stent ($): 21090] [Stereotactic Radiosurgery (%BC): 64.4] [Stereotactic Radiosurgery-Fractionated (%BC): 64.4] [Observation ($): 3978] [Emergency Department ($): 1382] [Urgent Care ($): 178] [Cardiac Rehabilitation Therapy ($): 217] [Cardiac Stress Test ($): 742] [Cardiology ($): 1584] [Echocardiology ($): 1146] [EKG/ECG ($): 178] [Electrophysiology Ablation ($): 11996] [Electrophysiology and Mapping Studies ($): 7330] [Holter Monitor/Telemetry ($): 317] [Peripheral Vascular Lab ($): 988] [EEG ($): 3612] [EMG ($): 664] [Neuropsychological Testing and Biofeedback ($): 540] [Sleep Studies ($): 1172] [Chemotherapy (%BC): 64.4] [Nuclear Medicine ($): 3120] [Oncology (%BC): 64.4] [Radiation Therapy  (%BC): 64.4] [CT Scan OP ($): 1542] [MRI OP ($): 2569] [Imaging Services ($): 126] [Mammography-Diagnostic ($): 258] [Mammography-Screening ($): 258] [Positron Emission Tomography ($): 3952] [Radiology ($): 532] [Ultrasound Imaging ($): 668] [Laboratory ($): 199] [Pathology ($): 199] [Hemodialysis (%BC): 64.4] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 64.4] [Occupational Therapy ($): 297] [Physical Therapy ($): 297] [Resp. Services/Therapy ($): 85] [Speech Therapy ($): 297] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1062] [IV Therapy (%BC): 64.4] [Pulmonary Function ($): 540]","count":"19","median_amount":2422.0,"10th_percentile":1436.54,"90th_percentile":2532.0,"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":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"27","median_amount":365.34,"10th_percentile":256.34,"90th_percentile":369.84,"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":"Youthcare","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."}]}]},{"description":"Bone marrow transplant","code_information":[{"code":"009","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hyphema","code_information":[{"code":"043","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Major Eye Infections","code_information":[{"code":"044","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neurological eye disorders","code_information":[{"code":"045","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders of the Eye Age >17 w CC","code_information":[{"code":"046","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders of the Eye Age >17 w/o CC","code_information":[{"code":"047","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders of the Eye Age 0-17","code_information":[{"code":"048","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head & Neck Procedures","code_information":[{"code":"049","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sialoadenectomy","code_information":[{"code":"050","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Salivary Gland Procedures Except Sialoadenectomy","code_information":[{"code":"051","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve & Oth Major Cardiothoracic Proc w Cardiac Cath","code_information":[{"code":"104","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve & Oth Major Cardiothoracic Proc w/o Cardiac Cath","code_information":[{"code":"105","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass w PTCA","code_information":[{"code":"106","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"107","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cardiothoracic Procedures","code_information":[{"code":"108","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"109","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Cardiovascular Procedures w CC","code_information":[{"code":"110","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Cardiovascular Procedures w/o CC","code_information":[{"code":"111","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"112","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Device Replacement","code_information":[{"code":"118","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vein ligation & stripping","code_information":[{"code":"119","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other circulatory system O.R. procedures","code_information":[{"code":"120","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute & Subacute Endocarditis","code_information":[{"code":"126","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Failure & Shock","code_information":[{"code":"127","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Deep Vein Thrombophlebitis","code_information":[{"code":"128","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head & Neck Procedures W Cc/Mcc Or Major Device","code_information":[{"code":"129","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head & Neck Procedures W/O Cc/Mcc","code_information":[{"code":"130","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cranial/Facial Procedures W Cc/Mcc","code_information":[{"code":"131","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cranial/Facial Procedures W/O Cc/Mcc","code_information":[{"code":"132","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/Mcc","code_information":[{"code":"133","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/Mcc","code_information":[{"code":"134","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hernia Procedures Except Inguinal & Femoral Age >17 w/o CC","code_information":[{"code":"160","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal & Femoral Hernia Procedures Age >17 w CC","code_information":[{"code":"161","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal & Femoral Hernia Procedures Age >17 w/o CC","code_information":[{"code":"162","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mouth Procedures w/o CC","code_information":[{"code":"169","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System O.R. Procedures w/o CC","code_information":[{"code":"171","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"G.I. hemorrhage w CC","code_information":[{"code":"174","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complex Aortic Arch Procedures","code_information":[{"code":"209","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":102808.87,"maximum":102808.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":102808.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":102808.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":102808.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":102808.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":102808.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":102808.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":102808.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":102808.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":102808.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":102808.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":102808.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":102808.87,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip & Femur Procedures Except Major Joint Age >17 w/o CC","code_information":[{"code":"211","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endovascular Abdominal Aorta With Iliac Branch Procedures","code_information":[{"code":"213","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":44779.16,"10th_percentile":44779.16,"90th_percentile":44779.16,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":52097.33,"maximum":52097.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52097.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52097.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52097.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52097.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52097.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52097.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52097.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52097.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52097.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52097.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52097.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52097.33,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"No Longer Valid","code_information":[{"code":"214","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With Mcc","code_information":[{"code":"222","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without Mcc","code_information":[{"code":"223","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With Mcc","code_information":[{"code":"224","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without Mcc","code_information":[{"code":"225","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc","code_information":[{"code":"226","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc","code_information":[{"code":"227","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other cardiothoracic procedures w/o CC/MCC","code_information":[{"code":"230","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major cardiovasc procedures w MCC","code_information":[{"code":"237","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major cardiovasc procedures w/o MCC","code_information":[{"code":"238","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents","code_information":[{"code":"246","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without Mcc","code_information":[{"code":"247","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents","code_information":[{"code":"248","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without Mcc","code_information":[{"code":"249","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Coronary Atherectomy Without Intraluminal Device","code_information":[{"code":"318","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":22415.37,"maximum":22415.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22415.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22415.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22415.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22415.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22415.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22415.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22415.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22415.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22415.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22415.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22415.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22415.37,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Appendectomy With Complicated Principal Diagnosis With Mcc","code_information":[{"code":"338","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy With Complicated Principal Diagnosis With Cc","code_information":[{"code":"339","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy With Complicated Principal Diagnosis Without Cc/Mcc","code_information":[{"code":"340","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy Without Complicated Principal Diagnosis With Mcc","code_information":[{"code":"341","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy Without Complicated Principal Diagnosis With Cc","code_information":[{"code":"342","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy Without Complicated Principal Diagnosis Without Cc/Mcc","code_information":[{"code":"343","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Coronary Atherectomy With Intraluminal Device With Mcc","code_information":[{"code":"359","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":31600.0,"maximum":31600.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31600.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31600.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31600.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31600.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31600.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31600.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31600.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31600.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31600.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31600.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31600.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31600.0,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Percutaneous Coronary Atherectomy With Intraluminal Device Without Mcc","code_information":[{"code":"360","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":31834.65,"10th_percentile":31834.65,"90th_percentile":31834.65,"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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":22343.98,"maximum":22343.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22343.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22343.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22343.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22343.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22343.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22343.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22343.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22343.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22343.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22343.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22343.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22343.98,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Laparoscopy & Incisional Tubal Interruption","code_information":[{"code":"361","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"D&C, Conization & Radio-Implant, for Malignancy","code_information":[{"code":"363","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"D&C, Conization Except for Malignancy","code_information":[{"code":"364","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Female Reproductive System O.R. Procedures","code_information":[{"code":"365","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"400","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Poisoning & toxic Effects of Drugs Age >17 w CC","code_information":[{"code":"449","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Spinal Fusion With Mcc","code_information":[{"code":"453","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Spinal Fusion With Cc","code_information":[{"code":"454","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Spinal Fusion Without Cc/Mcc","code_information":[{"code":"455","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical With Mcc","code_information":[{"code":"459","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical Without Mcc","code_information":[{"code":"460","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back & neck proc exc spinal fusion w/o CC/MCC","code_information":[{"code":"491","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Alc/Drug Abuse or Depend w/o Rehabilitation therapy w/o CC","code_information":[{"code":"523","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transient ischemia","code_information":[{"code":"524","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other heart assist system implant","code_information":[{"code":"525","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"527","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Vascular Proc w Pdx Hemorrhage","code_information":[{"code":"528","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular shunt procedures w CC","code_information":[{"code":"529","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular Shunt Procedures w/o CC","code_information":[{"code":"530","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal & Duodenal Procedures Proc Age > 17 w CC w/o Major Gi Dx","code_information":[{"code":"568","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urinary Stones W Esw Lithotripsy W Cc/Mcc","code_information":[{"code":"691","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urinary Stones W Esw Lithotripsy W/O Cc/Mcc","code_information":[{"code":"692","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section W Cc/Mcc","code_information":[{"code":"765","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section W/O Cc/Mcc","code_information":[{"code":"766","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery W Sterilization &/Or D&C","code_information":[{"code":"767","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery W/O Complicating Diagnoses","code_information":[{"code":"775","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ectopic Pregnancy","code_information":[{"code":"777","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Threatened Abortion","code_information":[{"code":"778","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"False Labor","code_information":[{"code":"780","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses W Medical Complications","code_information":[{"code":"781","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Mcc","code_information":[{"code":"984","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Cc","code_information":[{"code":"985","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W/O Cc/Mcc","code_information":[{"code":"986","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10457.41,"10th_percentile":10457.41,"90th_percentile":10457.41,"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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":1187.77,"10th_percentile":1187.77,"90th_percentile":1187.77,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"1 through 10","median_amount":15595.99,"10th_percentile":15595.99,"90th_percentile":15595.99,"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":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 16981] [Normal Vaginal Delivery-Case Rate: 12330] [Normal Newborn-Per Diem: 1221] [Lower Level Neonate-Per Diem: 1686] [Higher Level Neonate-Per Diem: 2036] [Severe Level Neonate-per diem: 6282] [Rehab-Per Diem: 2931] [SNF-Per Diem: 1298] [Bariatric Surgery-Case Rate: 37220]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 15511] [Normal Vaginal Delivery-Case Rate: 11262] [Normal Newborn-Per Diem: 1115] [Lower Level Neonate-Per Diem: 1540] [Higher Level Neonate-Per Diem: 1860] [Severe Level Neonate-per diem: 5738] [Rehab-Per Diem: 2678] [SNF-Per Diem: 1186] [Bariatric Surgery-Case Rate: 33998]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 156060 | Total % of Charge: 50] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 4.89 | Excess % of Charge: 39.87] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 4976.75] [Normal Vaginal Delivery-Per Diem: 4462.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 6.24 | Excess % of Charge: 42.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.29 | Excess % of Charge: 43.15] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5386.60] [Normal Vaginal Delivery-Per Diem: 4830]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 5.75 | Excess % of Charge: 46.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5855] [Normal Vaginal Delivery-Per Diem: 5250]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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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Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":760.0,"additional_payer_notes":"APC"}]}]},{"description":"Trgt gen seq alys pnl 83+","code_information":[{"code":"0326U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5000.0,"maximum":5000.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5000.0,"additional_payer_notes":"APC"}]}]},{"description":"Ftl aneuploidy trsmy dna seq","code_information":[{"code":"0327U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":795.0,"maximum":795.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":795.0,"additional_payer_notes":"APC"}]}]},{"description":"Onc neo xome&trns seq alys","code_information":[{"code":"0329U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3437.98,"maximum":3437.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3437.98,"additional_payer_notes":"APC"}]}]},{"description":"Onc hl neo opt gen mapping","code_information":[{"code":"0331U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1863.22,"maximum":1863.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1863.22,"additional_payer_notes":"APC"}]}]},{"description":"Caregiver traing 1st 30 min","code_information":[{"code":"97550","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":39.41,"maximum":39.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39.41,"additional_payer_notes":"APC"}]}]},{"description":"Caregiver traing ea addl 15","code_information":[{"code":"97551","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":21.25,"maximum":21.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21.25,"additional_payer_notes":"APC"}]}]},{"description":"Group caregiver training","code_information":[{"code":"97552","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.58,"maximum":9.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9.58,"additional_payer_notes":"APC"}]}]},{"description":"Rtm tx mgmt 1st 10 min","code_information":[{"code":"98979","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.86,"maximum":11.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11.86,"additional_payer_notes":"APC"}]}]},{"description":"Initial care training 30 m","code_information":[{"code":"G0539","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":39.41,"maximum":39.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39.41,"additional_payer_notes":"APC"}]}]},{"description":"Train for caregiver add 15","code_information":[{"code":"G0540","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":21.25,"maximum":21.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21.25,"additional_payer_notes":"APC"}]}]},{"description":"Safety plan interven","code_information":[{"code":"G0560","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":39.54,"maximum":39.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39.54,"additional_payer_notes":"APC"}]}]}],"modifier_information":[{"description":"Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit","code":"GY","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"PPO","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":"Core/Navigate Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"MMAI Medicare 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":"Cigna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","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":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","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":"MMAI Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","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":"Youthcare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Clia waived test","code":"QW","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"PPO","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":"Core/Navigate Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"MMAI Medicare 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":"Cigna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","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":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","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":"MMAI Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","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":"Youthcare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Services delivered under an outpatient physical therapy plan of care","code":"GP","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"PPO","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":"Core/Navigate Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"MMAI Medicare 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":"Cigna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","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":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","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":"MMAI Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","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":"Youthcare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Services delivered under an outpatient occupational therapy plan of care","code":"GO","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"PPO","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":"Core/Navigate Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"MMAI Medicare 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":"Cigna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","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":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","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":"MMAI Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","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":"Youthcare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Services delivered under an outpatient speech language pathology plan of care","code":"GN","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"PPO","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":"Core/Navigate Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"MMAI Medicare 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":"Cigna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","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":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","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":"MMAI Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","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":"Youthcare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Pregnant/parenting women's program","code":"HD","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"PPO","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":"Core/Navigate Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"MMAI Medicare 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":"Cigna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","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":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","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":"MMAI Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","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":"Youthcare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Distinct Procedural Service","code":"59","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"PPO","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":"Core/Navigate Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"MMAI Medicare 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":"Cigna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","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":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","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":"MMAI Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","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":"Youthcare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Reduced Services","code":"52","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"PPO","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":"Core/Navigate Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"MMAI Medicare 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":"Cigna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","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":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","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":"MMAI Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","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":"Youthcare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional","code":"76","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"PPO","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":"Core/Navigate Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"MMAI Medicare 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":"Cigna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","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":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","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":"MMAI Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","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":"Youthcare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Investigational clinical service provided in a clinical research study that is in an approved clinical research study","code":"Q0","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"PPO","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":"Core/Navigate Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"MMAI Medicare 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":"Cigna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","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":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","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":"MMAI Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","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":"Youthcare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Left side (used to identify procedures performed on the left side of the body)","code":"LT","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"PPO","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":"Core/Navigate Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"MMAI Medicare 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":"Cigna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","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":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","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":"MMAI Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","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":"Youthcare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Right side (used to identify procedures performed on the right side of the body)","code":"RT","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"PPO","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":"Core/Navigate Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"MMAI Medicare 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":"Cigna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","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":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","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":"MMAI Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","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":"Youthcare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities","code":"TC","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","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":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","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."}]}]}